Gray v. Romeo

• Author: DiSomma, Anthony V.

Gray v. Romeo

HELD: An incompetent patient's right to refuse life-sustaining

treatment, exercised on her behalf by her husband, is protected

by the due process clause of the fourteenth amendment and

common law notions of bodily integrity even when the effect

of refusing such treatment will cause the patient's death.

The plaintiff in this case sought a declaratory judgment which would authorize him to direct the removal of a feeding tube and other life support from his hospitalized wife Marcia Gray. Gray v. Romeo, No. 87-0573B (D.R.I., Oct. 17, 1988).

On January 4, 1986, Mrs. Gray lost consciousness after developing a sudden and serious headache. Id., slip op. at 3. A CAT scan and surgery revealed she had severe brain damage as a result of a massive hemorrhage within her cerebrum and within the meninges. She has never regained consciousness. On January 16, 1986, with the consent of Mr. Gray, a gastrostomy was performed by creating a hole in the abdominal wall and stomach through which a plastic tube was inserted in order to provide Mrs. Gray with nutrition and hydration. Id. at 3-4: Mrs. Gray was being fed a liquid diet every four hours through the tube and water was provided in between feedings. An endotracheal tube was inserted in her trachea for the purpose of removing mucus. Id. at 4. Shortly thereafter, she developed hydrocephalus, a buildup of excessive cerebrospinal fluid in the brain, which required additional surgery in order to insert a shunt to drain the fluid. Id.

The court appointed guardian ad litem described Mrs. Gray as being in a persistent vegetative state. Id.

PVS is a type of comatose state in which the cerebral functioning

has ceased but in which the brain stem functioning is fully or

partially intact. The brain stem controls primitive reflexes,

including activity, breathing, the sleep/wake cycle, reflexive

activity in upper and lower extremities, some swallowing motions

and eye movements. Marcia shows signs of each of these

activities. The cerebrum, on the other hand, controls sensations and

voluntary and conscious activities. Marcia's cerebrum has been

damaged severely, and as a result she displays no voluntary or

conscious movements, nor does she display any awareness or

sensation. This combination of reflexive activity in the absence

of sensation or conscious activity is characteristic of PVS. PVS

is generally a permanent condition. Id. at 4-5.

On May 20, 1987, Marcia Gray's family requested that her attending physician terminate feeding and permit Mrs. Gray to die. The hospital denied this request. Id. at 5. The neurosurgeon and consulting physicians were in agreement that there was" no reasonable likelihood of returning to a conscious state" for Mrs. Gray. Id. at 5-6. Mrs. Gray's treating physician since 1986 agreed that her chance for recovery was negligible. Her neurosurgeon believed that Mrs. Gray would not experience hunger, thirst, or pain upon termination of the feeding. Id. at 6.

The hospital is opposed to denying nutrition and hydration to Mrs. Gray because they believe it is euthanasia and inconsistent with the physician's role as safekeeper of his patient's well-being. Id. at 7. Other concerns include the fear of the hospital's civil or criminal liability and its reputation as a long-term care institution. Id.

The family was convinced of Mrs. Gray's desire not to prolong her life artificially if there was no hope...