Woman, 92, in Right-to-Die Case Succumbs

Anna Hirth, the La Mesa great-grandmother who unknowingly became the subject of a heated public debate about terminating the lives of the hopelessly incapacitated, died early Thursday morning at an undisclosed location in Southern California.

Mrs. Hirth’s daughter, Helen Gary of Calabasas Park, had fought in court since last fall to exercise her mother’s “right to die.” Mrs. Hirth, 92, was rendered virtually comatose after a choking incident early last year, and though she had left no directives for her care, Gary and other relatives argued that the once-feisty woman would never have wanted to be kept alive artificially.

Citing moral and medical constraints, her physician, Dr. Allen Jay of San Diego, resisted the family’s request that he remove the feeding tube that was keeping Mrs. Hirth alive--even after a San Diego judge who had traveled to Mrs. Hirth’s bedside to assess her condition ordered him in March to abide by the family’s wishes.

Move Out of County Urged

Superior Court Judge Milton Milkes later softened his decision, relieving Jay of the responsibility and urging Gary to move Mrs. Hirth out of San Diego County to some other location, where a doctor could be found to carry out the family’s wishes out of the glare of publicity. Right-to-life advocates had marched outside the La Mesa nursing home where Mrs. Hirth was residing, and no doctor could be found in the San Diego area to take over her case.

Unannounced, an ambulance carried Mrs. Hirth away from the Hacienda de La Mesa last week. Under the care of a doctor whose name has not been disclosed and circumstances her family declined to discuss in detail, Mrs. Hirth died at 2:30 a.m. Thursday.

A statement released by Gary’s lawyer, right-to-die advocate Richard Scott of Santa Monica, said Mrs. Hirth “died peacefully.”

Gary said her mother “died with dignity.”

“She was nourished and fed to the very end,” Gary said. “She was cared for in a first-class situation.” The daughter declined, however, to say if her mother’s nasogastric feeding tube was removed.

Doctors had testified that removal of the tube probably would result in Mrs. Hirth’s death within two weeks.

“I prayed that God would take her and let her go with dignity and peace,” said Mrs. Hirth’s sister, Doris Greenblatt of Desert Hot Springs.

The case was the latest--and one of the most closely watched--of a succession of court battles over the right-to-die issue.

Courts in California and other states have widely recognized that competent patients have the power to veto their doctors’ decisions about life-sustaining care, and thus to choose to end either medical treatment or artificial feeding if they do not wish to be kept alive by medical science.

‘Surrogate Decision-Makers’

But cases like Mrs. Hirth’s--in which patients are unable to speak for themselves and have left no clear expression of their wishes--have proven harder to grapple with. Increasingly, the preferences of so-called “surrogate decision-makers” have been recognized, but, as in Mrs. Hirth’s case, there sometimes is disagreement about who is in the best position to speak on the patient’s behalf.

Jay’s stance injected another complication into the equation. He and his lawyers insisted that health care professionals should not be forced to violate their personal ethics--especially if the question involves taking a step likely to result in a patient’s death. Milkes was unwilling to force Jay to act, or to force the nursing home staff to fill the void.

“I don’t know who deserves to live and who deserves to die,” Jay said Thursday. “I just hope we take a very conservative approach to whose life we terminate.”

Scott had appealed Milkes’ latest ruling, asking that the order requiring Jay personally to end Mrs. Hirth’s treatment be reinstated. Scott also asked the 4th District Court of Appeal to decide the case even if Mrs. Hirth died, saying health professionals needed further guidance about the limits of their powers in treating those who wish to die.

A Moot Point

However, Jay’s attorney, James McIntyre of San Diego, asked the appellate court to dismiss the case, arguing that it is moot in light of Jay’s replacement by another physician. Mrs. Hirth’s death, McIntyre said Thursday, “makes it even less likely the appellate court would continue to be involved in her case.”

Mrs. Hirth, a widow for 40 years, outlived two brothers, two sons and a daughter. Although she was increasingly incapacitated by Alzheimer’s disease even before the choking incident last year, family members said she had been a vital leader of her family well into her later years.