Hospital, family agree to withdraw life support

Massachusetts General Hospital and the family of a woman paralyzed from Lou Gehrig's disease agreed to withdraw her life support by June 30.

The hospital and family have been fighting in court for more than two years over whether to keep Barbara Howe, 79, on a ventilator. Since she was diagnosed with Lou Gehrig's disease in 1991, Howe has gradually lost her ability to speak, gesture, and even blink her eyes, leaving her unable to communicate her wishes in any way.

Mass. General doctors believe Howe is in pain and have pushed the family to allow the hospital to turn off her ventilator for two years. Howe's daughter, Carol Carvitt, is her healthcare proxy and has been unwilling to do so, saying her mother wanted aggressive treatment as long as she could enjoy her family.

Lawyers for the hospital and family negotiated behind closed doors for 3½ hours yesterday with Probate and Family Court Judge John M. Smoot. When they emerged, the lawyers read a three-paragraph statement that ''the parties have decided upon a course of action for the withdrawal of Barbara Howe's life-sustaining treatment by June 30."

The statement said the court entered a one-week order prohibiting the parties and their lawyers from discussing the case with the news media ''out of respect for the privacy of Barbara Howe."

As a result, the lawyers declined to answer questions about the agreement and what has changed the mind of Carvitt, who has fought steadily for years to keep her mother alive.

In their statement, the two sides also tried to mend fences after two years of sometimes angry disagreement over Howe's care. The hospital ''acknowledges that the family has acted out of love and concern for their mother, and the family acknowledges that the hospital acted with similar concern for their patient and that Barbara would not have received better care anywhere else."

The agreement appears to bring to a close a long and heart-wrenching situation, not only for Howe, but also for her family and caregivers. The case has attracted national media coverage, fueled arguments on websites, and highlighted the debate about how much care is appropriate for terminally ill patients.

Physicians and lawyers who specialize in end-of-life issues say that often it is relatives and patients, not doctors, who want more aggressive care. In an article in the Journal of the American Medical Association five years ago, 48 percent of patients surveyed wanted all available treatments, no matter what the chance of recovery, while only 7 percent of physicians rated that important.

Nurses referred to Howe as a ''war horse" and said she ''wanted everything done to maintain her; including CPR, antibiotics, and ICU." Howe seemed impervious to pain, her family marveled. ''In fact, she'd say to bring it on," Carvitt's lawyer, Gary Zalkin, is quoted as saying in hospital records.

Carvitt said she has tried to fulfill her mother's wishes and believed she could still hear and maybe see her family. But after Howe's bones broke during routine turning and doctors had to remove her right eye because of corneal damage, her caregivers grew increasingly opposed to keeping her on a ventilator.

Last spring, Smoot refused the hospital's request to overturn Carvitt as her mother's healthcare proxy. But, the judge said, since Howe could not have foreseen all her medical complications, he told Carvitt to refocus from carrying out her mother's wishes to acting in her best interest.

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