Plan to take woman off life support is halted

Doctors at Massachusetts General Hospital canceled plans to withdraw life support today from an elderly woman they believe ''is suffering significantly and needlessly," until a judge considers objections from the woman's daughter.

For at least two years, the hospital has wanted to turn off the breathing machine for Barbara Howe, who suffers from Lou Gehrig's disease and has been hospitalized at MGH for more than five years. But Howe's daughter, Carol Carvitt, who as her mother's health care proxy is legally authorized to make medical decisions on her behalf, has fought the hospital, saying her mother wanted to be kept alive as long as she could appreciate her family.

''I am very relieved to learn that my mother is not going to have her life taken away" today, Howe said in a statement read by her attorney, Gary Zalkin. ''I am glad that the hospital has decided to go back to court, rather than act against the family's wishes, against the health care proxy, and against the last court judgment."

It is rare for a hospital in the United States to try to overturn the wishes of a patient's health care proxy, but MGH doctors and Carvitt adamantly disagree about what is best for Howe and even about the nature of her condition.

Carvitt has said that when she walks into her mother's hospital room, Howe widens her good left eye and looks at her, a glow in her face. But doctors have said that Howe is ''locked in" her own body, and in June 2003, the head of the hospital's end-of-life committee, Dr. Edwin Cassem, a Jesuit priest and psychiatrist, wrote that ''the patient's status has surpassed an acceptable limit endangering her integrity, dignity, humanity, and basic human rights."

Health care lawyers say the Howe case could influence the outcome of future disputes between doctors and families and that it highlights the debate about how much care is appropriate for terminally ill patients.

In a few other cases, hospitals have tried to overturn the decisions of health care proxies; court rulings have gone both ways.

''There is no clear legal precedent," said Charles Sabatino, assistant director of the American Bar Association's Committee on Law and Aging in Washington, D.C. ''In the few cases where hospitals have tried to overturn family's decisions, the discussion has revolved around whether the treatment is futile and what's in the best interest of the patient. Very few cases go to court, because the provider and family usually reach an agreement."

The small but growing use of living wills and health care proxies has affirmed the rights of patients and their surrogates to make decisions about when ''enough is enough," Sabatino said. ''But when you get into an outright difference of opinion between the surrogate and the provider, there are no easy guidelines."

The Globe originally wrote about the disagreement at Mass. General in September 2003, soon after the hospital went to court to try to overturn Carvitt's wishes. In a decision in March 2004, Probate and Family Court Judge John M. Smoot said Carvitt's wishes as her mother's healthcare proxy stand, because Howe's wishes at that time were ''unknown and unascertainable."

But this month, Mass. General, told Carvitt they again planned to remove her life support, saying that Howe's condition has worsened. Carvitt's lawyer, Zalkin, asked for a temporary restraining order to stop Mass. General from taking that step, but the court denied the order earlier this month. Yesterday Zalkin filed a petition with the court asking the judge to affirm Carvitt as her mother's health care proxy.

''We still believe it's not Carol's job to have to do that," he said. ''If the hospital wants to disregard the health care proxy, they should be the ones to have to go to court."

The hospital's lawyer, Robert Hamel, did not return a telephone call from the Globe yesterday. But in a written statement, Mass. General said it would honor Carvitt's wishes for clarification from the Probate Court. Hospital executives and doctors have not explained why they feel withdrawing Howe's life support is within their rights, despite the court's March ruling, saying only that her condition has deteriorated within the past year.

In the statement, the hospital said Howe has been dependent on mechanical ventilation for more than eight years and has had serious complications. ''It is not our goal to end Mrs. Howe's life, but rather to cease care that is inappropriate and harmful, indeed inhumane," the statement said. The hospital said that continuing her care in its current course is ''inconsistent with the first tenet of our Hippocratic Oath, 'Do no harm.' "

The hospital also said it would assist the family to transfer Howe to another facility that would provide appropriate care. Carvitt could not be reached after the hospital released the statement.

In another highly publicized case, a Florida appeals court yesterday cleared the way for Michael Schiavo, husband of Terri Schiavo, to remove his wife's feeding tube, over the objections of her parents. She suffered severe brain damage 15 years ago when a health condition caused her heart to stop and shut off oxygen to her brain.

As in the Howe case, what the mother and father see when they look at Terri Schiavo ''is 180 degrees different and contradicts what every neurologist sees," Sabatino said.

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