GA law allowing doctors to unplug life support challenged (Drs. don't need family's Consent)

Alicia Fennell had just one hour to save her husband's life. Doctors at Emory Eastside Medical Center in Snellville said he was brain dead and being kept alive by life support. She and her children doubted the diagnosis, sensing that somehow Donald Fennell was still aware. The hospital was preparing to pull the plug at 5 p.m. Dec. 4, with or without the family's consent, but a last-ditch effort to stop the hospital was about to play out at the Gwinnett Justice and Administration Center. The struggle between hospital and family occurred because the Fennells, like many people, didn't know Georgia law leaves the final decision on discontinuing life support for brain-dead patients to doctors, not family members.

The family will bury Donald Fennell on Saturday in Daytona Beach, Fla., near his home in Palm Coast. What they cannot bury is a lingering frustration with a hospital they say treated them unfairly and a law that leaves families out of the loop. The hospital declined to discuss specifics of the case because of patient confidentiality, but issued a statement saying, "we are confident, based on the assessment of numerous physicians who consulted on this patient's care, that he has received the highest quality care available."

Loved one lost

Donald Fennell, 50, suffered a massive stroke Nov. 30 while visiting his daughter in Snellville. Family members said he complained of a headache while watching television, then began slurring words. An ambulance transported him to Emory Eastside. The next day, doctors told the family the stroke caused massive bleeding in Donald's brain. Four different physicians examined Fennell and his brain scans and determined his brain, including the brain stem which controls basic bodily functions like breathing, had ceased to function, according to court and patient records.

The family held out hope that he would come back to them. Little signs fed their doubts about the diagnosis — a twitch of the hand, a jerk of the tongue — and they noticed his breathing quickened when they spoke to him or massaged him, Alicia Fennell said. "We felt like he heard us," said his daughter, Tanika Coulibaly. "[The doctor said] we probably thought we felt him move, but we couldn't have."

Squaring off

Discord started the first day the family visited the hospital. Alicia Fennell says a nurse called police to escort the family out of the hospital because Fennell's three sons —21, 20 and 18-year-old college football players— cried loudly and shouted "No!" when told their father was brain dead. After that, she said, security guards were posted at the door whenever they visited. The Fennells wanted hospital administrators to move him to a Veterans Affairs hospital near his home in Palm Coast, Fla. The hospital told them nothing could be done to improve Fennell's condition, Alicia Fennell said, and they were prepared to terminate life support even without the family's consent.

Doctors scheduled removal of life support for 5 p.m. Dec. 4. "They told me they already had four opinions from their doctors, and that was all they needed," Alicia Fennell said. "They told me that it's not my decision no more, it's not the family decision anymore, it's a state law." Emory Eastside Medical Center doctors cited a Georgia law which says that a patient can be pronounced dead once a physician determines there has been "irreversible cessation of all functions of the entire brain, including the brain stem."

Last-ditch effort

Shortly before 4 p.m. Dec. 4 —one hour before the hospital planned to remove life support— Alicia Fennell rushed toward the courthouse in Lawrenceville, desperately seeking a judge to intervene on behalf of her husband of 28 years. She filed a petition at 4:23 p.m. With 10 minutes to spare, Superior Court Judge Tom Davis telephoned hospital administrators and told them to keep life support going. He scheduled a hearing at 9 p.m. to discuss the family's concerns. Then, long after the courthouse had closed, the judge took another unusual step. He accompanied the family to Fennell's bedside at 11 p.m. to personally assess his condition.

The family had been insistent that Fennell was responding to their voices and touch by breathing faster, but doctors said it only appeared that way because they were bumping the bed —a disturbance recorded on the ventilator. Davis called everyone back into court at 11:30 a.m. the following day. He asked Chief Medical Officer Michael Heisler at Emory Eastside to bring CAT scans and explain the test results to the family in a way they could understand. He also consulted with a chief administrator for the VA hospital in Decatur, who said it was unlikely they would accept someone in Fennell's condition for a transfer.

Alicia Fennell says that until the court hearing, doctors had never fully explained her husband's condition. It was also the first time she'd seen CAT scans. Previously, hospital workers told the family the machine wasn't working, she said. Upon hearing the testimony, the family decided to go along with whatever the judge decided. Davis authorized the hospital to discontinue life support for Donald Fennell on Dec. 6. He passed away that afternoon with his wife, sister and all of his children at his bedside.

An ounce of prevention

End-of-life issues such as this have been fodder for a heated national controversy ever since the Terry Schiavo case made headlines in 2005. Schiavo, 41, was a brain-damaged Florida woman living in a vegetative state. Her feeding tube was removed, and she was allowed to die by a court ruling at the request of her husband, but only after her family waged a seven-year legal battle. Georgia Right To Life, a nonprofit organization that opposes abortion and euthanasia, says Fennell's death is part of a larger debate on what they call the "futile care theory." The theory says that when a patient reaches a certain stage of age, illness, or injury, any further treatment other than comfort care is futile and should be withheld.

Said Josh Brahm, a spokesman for Georgia Right to Life, "It is plain and simply a value judgement —a value judgement being made by someone who doesn't know you." Liz Schoen, an attorney for the Georgia Hospital Association, said issues involving brain damage and brain death are complex. "It's up to the physician and other medical staff to make sure what the patient would have wanted and what the family wants," Schoen said. "Usually, the hospital will abide by that. Courts remain available in the event of disagreement between the two parties."

Sitting down with family members, discussing your end-of-life wishes and creating a living will or "advance directive" can eliminate a lot of worries when a crisis arises, Schoen said. "This situation is exactly what [an advance directive] is intended to prevent," Schoen said. "We encourage everybody to sign one." Donald Fennell didn't have a living will, but the Fennell family still harbors resentment about the "cold-blooded" way that the hospital treated them. "I didn't know that people would actually treat you this way at a time like this," Alicia Fennell said.

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.