McConnell v. Beverly Enterprises.

• Author: DiSomma, Anthony V.

McConnell v. Beverly Enterprises

HELD: The health care facility must cease administering

medication and desist providing any further artificial life-support

systems (including nutrition and hydration) to the patient.

Since a patient's right to self-determination overrides other

societal interests in the preservation of life, no civil or criminal

liability will attach upon the removal of the gastrostomy tube.

The entire immediate family of Carol McConnell acted as the plaintiffs in this action which sought to enjoin the attending physician and the personnel associated with the Danbury Pavilion Healthcare Nursing Home from administering any life prolonging care for their relative. McConnell v. Beverly Enterprises, No. 0293888 (Super. Ct. Jud. Dist. Danbury, Conn. July 8, 1988) (Dranginis, J.).

Fifty-six year old Carol McConnell was involved in an auto accident in which she sustained traumatic brain injuries. With John McConnell acting as the court appointed conservator, the plaintiffs also requested the court to declare that the removal of the gastrostomy tube would not subject the physician or the medical institution involved to any criminal or civil liability (hereinafter referred to as the "Danbury Pavilion"). Id.

Being unable to chew or swallow food, the sole means of nutrition for Carol McConnell was the gastrostomy tube. She never regained consciousness after the accident. Id. at 2. The court acknowledged that the removal of the gastrostomy tube would result in dehydration and death. Id.

The plaintiffs aggressively asserted that Carol McConnell maintained a personal stance against the use of life support systems to prolong life where no hope of a cognitive recovery existed. Id. The other contention put forward by the plaintiffs was that continued tube feeding against the patient's wishes violated her federal and state constitutional right to privacy and commonlaw right to self-determination. Id. The plaintiffs requested that any death resulting from the removal of the tube should be categorized as one resulting from natural causes. Id.

The defendants claimed that Connecticut General Statutes, sections 19a-570 to 575, dealing with the removal of life support systems is not applicable to this patient because she was not in a terminal condition. More importantly, the defendants asserted that the removal of the gastrostomy tube is prohibited under section 19a-570(1) which excludes the provision of nutrition and hydration. Id. at 2-3.

The court readily admitted that the case presented profoundly difficult legal issues which required a scrutinized balancing of conflicting interests. Id. at 3. Proffered evidence and testimony allowed the court to examine both McConnell's background and her medical status. Id. at 5. Of great consequence to the court was the fact that Carol McConnell was a registered nurse who worked first in the operating room and then in the emergency room at the very same hospital in which she became a patient. Id. She was described by her three children as strong and independent and dedicated to her patients, and that she was ultimately promoted to department manager. Id.

McConnell's work as a nurse promulgated a different perspective on the case since she was able to observe firsthand the status of patients with traumatic brain injuries. Id. Reference was made to Carol McConnell's phobia about head injury and her opposition to the use of artificial life sustaining technology. Id. Testimony elicited from two colleagues revealed McConnell's experience with persistent vegetative state patients and her vocal opposition to life-sustaining measures. Id. at 7. According to one witness the definition of terminal adopted by Carol McConnell exists where "there is no hope of living a normal life in an independent and self-caring way." Id. The court viewed this quantum of evidence as being clear and convincing of her wish to avoid life prolonging measures. Id. at 8.

Although Carol McConnell's prognosis for recovery was termed as being dim given her persistent vegetative state status, her brain stem activity was intact and she was able to breathe without the use of a respirator. Id. McConnell was also able to open her eyes and `rove,' move her mouth, cough, gag, and flex her toes and fingers. Id. at 7-8. The massive trauma of the cerebral cortex contributed to her inability to see, hear, speak, smell, taste, feel, or think. Id. at 9. Carol McConnell also had to combat a fluid and mucous buildup in her lungs. These and other factors required full-time labor intensive medical attention. Id. Removal of the gastrostomy tube would result in McConnell's death within a period of fourteen days, however she could expect to live five to ten years if the tube was left in place. Id. at 10.

The evidence revealed conflicting testimony concerning Carol McConnell's responses to various stimuli. This evidence was later reflected by Dr. Ruxin's medical findings. Id...