Care and Protection of Beth – Persistent Vegetative State
Care and Protection of Beth, 412 Mass. 188, 587 N.E.2d 1377 (1992).
NATURE OF THE CASE: This lawsuit involved a dispute over the determination to enter a no code order against an infant in a persistent vegetative state.
FACTS: Beth was born in 1986 to a mother and father who were both minors. Less than a month after birth the child was the subject of a petition by DSS which found that the Beth was in need of care and protection. A few weeks later the child’s mother was also found to be in need of care and protection. In December, DSS returned physical custody of the child to the mother while retaining legal custody. Shortly thereafter both the mother and the child were involved in a car accident and the child was left in an irreversible coma. The child cannot hear, see, or engage in any purposeful movement. Her ability to breathe on her own is extremely limited and she requires a machine and breathing tube. She has extreme medical problems and suffers from repeated cardiorespiratory failure as a result of aspirating food. Extensive medical treatment is needed. A guardian was appointed to represent the child. Expert testimony indicated that the child was in an irreversible coma and that a no code entry was consistent with medical ethics. The Judge substituted his judgment for the incompetent child and found that if competent, the child would choose not to be resuscitated by extraordinary measures. The guardian appealed this order.
ISSUE: May a judge rule on substituted judgment on a minor child who was less then three months old when she entered a vegetative state and who is now five and half years old?
RULE OF LAW: Yes. A judge may rule on substituted judgment on a minor child who was less then three months old when she entered a vegetative state and who is now five and half years old.
HOLDING AND DECISION: The judge in this case found the following facts: 1) because of her infancy the child had not expressed any wishes from which the judge could draw guidance; 2) because of the absence of natural family involvement there is no information regarding the child’s ethical, moral, or religious values that the court could examine; and 3) there would be little impact on the family as the family was not involved. The child had also made no gains during her long hospitalization and at best she would live for an indefinite period of time in a vegetative coma without any real hope of improvement.
DISPOSITION: Affirmed.
DISSENT: Those acting in behalf of others who must decide whether to take extraordinary means to prolong life are not required to invoke those means. Under this situation, the court has allowed the exercise of substituted judgment when there is no evidence to support it. The child is not five and a half years old and there is no evidence that she would elect death to a life with no cognitive ability.