No One Willing to End Hirth’s Life : Frustrated Judge in ‘Right to Die’ Case to Assign Responsibility

When a Superior Court judge signed an order 10 days ago permitting the removal of a feeding tube that is keeping 92-year-old Anna Hirth alive, the La Mesa woman’s relatives breathed a sigh of relief.

At last, Hirth’s daughter Helen Gary believed, the comatose woman would be granted her wish to become free of life in a vegetative state.

But so far, things haven’t worked out that way. In spite of Judge Milton Milkes’ court order that Hirth had a “right to die,” neither her doctor nor medical personnel at the Hacienda de la Mesa nursing home where she lies bedridden are willing to terminate the life-sustaining treatment.

Hirth’s physician, Dr. Allan Jay of San Diego, believes it is neither medically nor morally proper to remove the nasal feeding tube and has refused to do it. His attorney says Jay has consulted “30 or 40” other physicians but has been unable to recruit another doctor to perform the medical procedure, which will mean almost certain death for the frail woman.

Nurses at Hacienda de la Mesa, meanwhile, also have refused to end care for Hirth, either because they do not wish to bear such a grave responsibility, or out of fear that they could somehow be held legally liable for ending the elderly woman’s life.

Lack Medical Training

The nursing home’s attorney, Douglas Walters, said that if nurses are unwilling to remove the tube, “it might come down to a point where the hospital administrators would have to do it, and they are simply not medically trained in that area.”

On Wednesday, Milkes reentered the fray. The judge issued a stay of his order directing that the feeding tube be removed by April 6 and set April 15 as the date for a hearing to clarify the issue of who will assume responsibility for ending the artificial life support.

Richard Scott, the noted right-to-die advocate from Santa Monica serving as attorney for Hirth’s family, said the judge’s order “affirms his earlier ruling that the tube will be removed” and simply leaves open the question of “who will be given authority to put an end to Mrs. Hirth’s pitiful condition.”

Scott added that the judge plans to meet with attorneys for all sides in the case before April 15 to discuss his options.

“It is my hope that we can find some way around this problem in the near future, because this is not doing Mrs. Hirth any good,” Scott said. “Every day is an outrage as far as Mrs. Hirth is concerned and now, to have it prolonged for another nine days, is very, very distressing.”

Hirth, incapacitated by Alzheimer’s disease for several years, fell into a coma in February, 1986, after choking on some food.

Described by relatives as a feisty, domineering woman before she lost her health, Hirth left no clear guidance about whether she wished to have her life extended by artificial means or whether she opposed the idea. But relatives say she loathed the thought of being kept alive in a nursing home.

So, several months after Hirth fell into a coma, Gary, of Calabasas Park, asked Jay to take steps that would allow Hirth to die. When Jay refused, Gary hired Scott, who also represents Elizabeth Bouvia, a Los Angeles-area woman immobilized by cerebral palsy who last year won the right to refuse force-feeding.

Sought Court Order

Scott filed a lawsuit seeking a court order disconnecting Hirth from life-support systems. Jay and nursing home officials, meanwhile, continued to oppose the move and raised doubts about the family’s knowledge of Hirth’s wishes.

After a lengthy court process that involved a highly unusual visit by Milkes to Hirth’s bedside, the judge on March 23 signed an order allowing removal of the feeding tube. Under the ruling, Jay was directed to disengage the tube by April 6. If he declined, he was instructed to find another doctor to perform the procedure or leave the task to the nursing home.

On Wednesday, Jay’s attorney, James McIntyre, said the physician had consulted several dozen medical colleagues but could find no one willing to take over the Hirth case.

“Dr. Jay remains opposed to the idea, and it is our belief that since no one has stepped forward up to this point, there is no one willing to do this,” McIntyre said.

Apparently, Jay even attempted to persuade Scott--who is a licensed physician--to assume care for Hirth. Scott said he received a certified letter from Jay Tuesday.

“In view of your particular interest in the case involving Anna Hirth, I am requesting that you assume medical care of Anna Hirth at this time,” Scott quoted the letter as saying.

Scott said he was “astonished” by the request and declined: “That’s a preposterous idea. I live in Los Angeles.”

As for the nursing home, Walters said nurses there are uneasy about bearing responsibility for removal of the tube--despite the fact that Milkes’ order would protect them from any liability in Hirth’s death.

“The nurses are concerned about their liability if they were to carry out this procedure without a doctor present,” Walters said. He noted that there is a dispute about whether a judge has the power to grant immunity in certain right-to-die cases.

There are other problems with the judge’s order, Walters said. It specifies that the nasal tube be removed in a “medically competent manner,” and “if we come down to a point where someone who is not medically trained does it, then we would not be in compliance with the judge’s order,” he said.

Scott, meanwhile, is growing impatient with the flap over who will terminate care for Hirth. He said removal of the tube is “something nurses do frequently” when the tubes are cleaned or replaced. The attorney said the procedure is “as easy as changing the cartridge on an electric typewriter.”

“I really hope that Dr. Jay will see fit to put his feet to the fire and end Mrs. Hirth’s suffering,” Scott said. “Barring that, I hope that Judge Milkes will order him to do it. That is what I will be pressing for.”

Gary could not be reached for comment Wednesday.