Judge rules Mass. General can't end life support for Gehrig's disease patient

A judge has ruled that Massachusetts General Hospital cannot withdraw life support from an elderly woman who has been hospitalized with Lou Gehrig's disease for more than four years.

In an unusual and painful situation, doctors at New England's largest hospital and the woman's daughter bitterly disagree about her care. Carol Howe, Barbara Howe's oldest daughter and her healthcare proxy, argues that her mother wants aggressive treatment as long as she shows signs of brain function and appreciates her family. Barbara Howe has been on a breathing ventilator since 1997. She cannot eat, speak, or indicate when she's suffering.

Mass. General doctors believe Howe is suffering and would not have wanted to be kept alive in her current condition. They took the rare step of going to court to try to overturn Carol Howe's wishes as her mother's healthcare proxy.

Charles Baron, a law professor at Boston College who pushed for passage of the state's healthcare proxy law, said it's rare for a hospital to try to overturn a family member as healthcare proxy -- the person a patient chooses to make healthcare decisions if he or she becomes unable to do so.

In his March 18 decision, Probate and Family Court Judge John M. Smoot said that Carol Howe's wishes as her mother's healthcare proxy stand. But he advised her to refocus not on determining what her mother would want but on what's in her best interest now.

Smoot also agreed with the hospital on one front, saying doctors may not take any more aggressive measures to keep Barbara Howe alive, such as shocking her heart if it stops.

The arguments during the February trial centered around what Barbara Howe feels, thinks, or suffers. Lou Gehrig's disease attacks nerve cells in the brain and spinal cord until patients are completely paralyzed. In most cases, their minds remain sharp.

''She may be fully conscious," Smoot wrote. ''The hospital concedes that what Barbara sees, hears or feels is not known."

Gary Zalkin, Carol Howe's attorney, said the judge confirmed that Carol Howe makes the decisions for her mother.

''It's good Barbara's wishes were honored," Zalkin said.

Dr. Britain W. Nicholson, Mass. General's chief medical officer, said it had been ''an extraordinarily difficult situation for both the Howe family and ourselves. We've really been trying to do what's in the best interest of Mrs. Howe."

Liz Kowalczyk can be reached at kowalczyk@globe.com.