Hospital tries to end patient's life support

Massachusetts General Hospital renewed its effort to withdraw life support from an elderly woman who has been hospitalized with Lou Gehrig's disease for more than five years, despite objections from her daughter.

Barbara Howe has been on a breathing ventilator since 1997. She cannot eat, speak, or indicate when she's suffering, except to grimace occasionally. Mass. General doctors and a hospital end-of-life committee that evaluates difficult cases believe Howe is suffering and would not want to be kept alive in her current condition.

But Howe's daughter, Carol Howe Carvitt, who is also her mother's healthcare proxy, believes her mother would want to be kept alive, and that she still can see out of one eye and appreciate visitors. The Globe wrote about the disagreement in a September 2003 story.

Mass. General took the rare step of going to court to try to overturn Carvitt's wishes as her mother's healthcare proxy, a person the patient chooses to make healthcare decisions if he or she becomes unable to do so. In a decision in March, Probate and Family Court Judge John M. Smoot said Carvitt's wishes as her mother's healthcare proxy stand, and that the hospital could not disconnect the life support.

But he advised her to refocus not on determining what her mother would want but on what's in her best interest.

Now, Mass. General, based on a recent evaluation and recommendation from the hospital's end-of-life committee, has told Carvitt it plans to disconnect her mother's life support as soon as Feb. 23.

Dr. Britain Nicholson, Mass. General's chief medical officer, said confidentiality rules prohibited him from discussing in detail why the hospital is again trying to disconnect Howe's life support. But he said her "condition has continued to deteriorate."

"Both sides are trying to do the right thing here, but there are different views about what is the right thing," he said. "So, unfortunately, we're going to have to go the legal route again. We understand how difficult the situation is for the family, and we're trying to support them through this process."

Carvitt said she felt devastated and angry that the hospital, in her view, is violating the court judgment.

"She's still alert; she still has her left eye; she still opens her eye and looks at me; and you can just see the glow in her face," Carvitt said.

Nicholson said the hospital does not believe it needs to return to court to have the order overturned, partly because Carvitt's attorney, Gary Zalkin, this month asked for a temporary restraining order to stop Mass. General from disconnecting the life support, and the court said no. Zalkin said that occurred before the hospital's decision was official and that he's evaluating how to proceed, but believes it's Mass. General's responsibility to ask permission from the court.

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