Judge Acts to Let Comatose Woman Die

An elderly woman who has been unconscious in a nursing home for more than seven years can be allowed to starve to death at the request of her family, despite her doctor’s objections, a Superior Court Judge said Thursday.

But Judge Warren Deering said he would not issue an order to remove the feeding tube that is 77-year-old Avis Flott’s last hold on life until doctors, family members and state licensing officials submit a proposal for carrying out his order.

“I do not believe it’s sufficient to issue an order and then leave the facility and the doctors to guess about who is to do it and how it’s to be done and what kind of treatment the patient should be given pending her demise,” said Deering, responding in part to the nursing home medical staff’s reluctance to end the life of a patient they have cared for since 1979.

Flott was left comatose by a 1979 automobile accident and since has been kept alive at the El Monte Golden Age Convalescent Hospital, fed a 1,200-calorie-a-day liquid diet through a tube into her stomach.

‘She’d Have Been Horrified’

It is a life her two daughters say their mother never would have wanted to live. They say she had told them repeatedy over the years that she did not want to be “kept alive on machines” or by any artificial means.

“Had she known that what is currently occurring was possible, she would have been horrified,” Flott’s daughter, Vivian McMahon of West Covina, told the court.

But Flott’s doctor and nursing home officials, citing concerns over state licensing requirements and longstanding policies against allowing patients who are not on any other life-support equipment to starve, refused to disconnect the tube when McMahon first requested it in April.

“Since you have in a nursing home approximately 20 to 30% of the patients who don’t have any quality of life, cannot make any decisions, any family could make similar requests for other reasons than Mrs. Flott’s family made,” including financial reasons, Flott’s doctor, Kurt Gunther, said in court documents.

The case was further complicated in Gunther’s view by the fact that Flott’s husband, who visited his wife daily before his death in April, never expressed a wish to end her life.

In fact, Gunther said, Flott’s husband had regularly told him to “do whatever I could” for the comatose woman.

McMahon and her sister, Florence DuBois, said they waited until after their father’s death to raise the issue of their mother’s treatment because their father, who had suffered a heart attack, seemed to be comforted by his daily visits to Mrs. Flott.

“He was in ill health. But yet, knowing that mother was still alive kept him going. He’d get up and get dressed and go see mother,” McMahon said in an interview.

But toward the end, their father seemed to change his mind, DuBois added. “He said if anything happened to him, he’d take Mother with him if he possibly could.”

The case also is clouded legally by the fact that Flott is in a nursing home, rather than a hospital.

California courts have established in recent years that hospital patients have the right to refuse medical treatment, most recently in the case of Elizabeth Bouvia, a quadriplegic who won removal of a similar feeding tube.

But there are no clear guidelines on how nursing homes licensed by the state must deal with patients who may be too ill to express their own wishes, said Kenneth Stern, who is representing the Golden Age home.

A California nursing home which five years ago removed a nasogastric feeding tube on the order of a physician who had treated the patient for nearly 20 year--and clearly knew his wishes--was cited by the state for “patient abuse” and threatened with a $5,000 fine. The citation was lifted only after the tube was replaced.

Temporary state guidelines now in effect suggest that “artificial feeding” can be discontinued in some instances when a patient is in an irreversible coma. But artificial feeding in that instance is defined as intravenous feeding, and the guidelines do not speak to a patient who is fed through a tube.