This entry is a little late.

Others have been writing about the battle over the guardianship of Dorothy Livadas, a battle that has life and death consequences. Both Wesley Smith and Thaddeus Pope have written about the messy situation surrounding Dorothy Livadas.

Interestingly, both Wesley and Pope have termed this case as one revolving “futility.”

I respectfully disagree.

Here’s the short version:

Dorothy Livadas has been in a coma for over five months. She signed a detailed living will that indicated she didn’t want ventilation or tube feeding if she was in a nonresponsive state and not expected to recover. On the other hand, she also named her daughter Ianthe as her medical durable power of attorney, specifically giving her the power to order withdrawal of “extraordinary” measures.

It’s pretty clear that the current situation is what the elder Livadas had in mind when she talked about setting limits to her care. The conflict in this case is that she chose someone to make decisions for her who is apparently going against the elder woman’s written wishes.

In the face of this conflict – and no doubt wanting to free up the hospital bed- the hospital went to court to remove Ianthe Livadas as her mother’s guardian.

On the face of it, this is not about “futility,” but about a case in which there is a real dilemma in regard to what the wishes of Dorothy Livadas would be about her fate. Which should primacy? – her written wishes or the judgments of her appointed decisionmaker?

That makes it all sound so rational and reasonable when I read it, but it really is messier than that. See, Dorothy Livadas is judged to be in a persistent vegetative state. So I was really surprised when I read the opening paragraphs of this August 11th article from the Rochester Democrat & Chronicle:

When Ianthe Livadas arrives at Strong Memorial Hospital, a trio of doctors is hunched over her 97-year-old mother, tapping tendons to check reflexes.

To the rhythm of the ventilator, Dorothy Livadas’ chest rises and falls. A tube stretches from the machine into her mouth.

After a few minutes, the neurological consultant tells Ianthe there’s no sign of brain activity. He asks if she’s familiar with the concept of brain death. (emphasis added)

Brain Death?! Where did that come from? A determination of “brain death” in this state carries legal weight – meaning you can’t demand medical treatment for someone who has been pronounced “brain dead.”

So that was the big issue on my mind when the local ABC affiliate called to interview me for NDY’s take on the Livadas case. You can view the video here, along with the obligatory introductory commercial.

Below is a transcript of the portion of the segment containing my interview by reporter Jane Flasch:

Flasch: Ianthe Livadas filed papers that indicate a physician at Strong made an error when he testified that Dorothy Livadas was brain dead on August 8th. The court papers also allege a week later more medical testing happened and the doctor reversed his decision, declaring she was not brain dead after all.

Now, advocates for Not Dead Yet – that’s an organization which helps patients fight for the right to receive life support care – says there is a very important difference between someone who is brain dead and someone who is in a persistent vegetative state.

Drake: Brain death is supposed to be a clear bright legal line and in fact there would be no court case in New York State if she in fact met the criteria for brain death. You can’t argue for maintaining the life support on somebody who basically has been declared dead. It is a definition of death. And yet here they are (the hospital) pushing that envelope.

Update: On August 2oth, the Appellate Division of the state Supreme Court removed all barriers to removal of life support from Dorothy Livadas. As of today, there is no word of any action being taken.

As I said, this case should be a little more straightforward – and both the local newspaper and the ABC affiliate have done a commendable job in trying to provide straight coverage on this case.

Just a few nagging things…

Has Strong Memorial Hospital ever gone to court to remove someone as a guardian when they were acting in a way that would remove life-saving measures even if it appeared to go against the individual’s written preferences?

Were some doctors playing word (and head) games with both Ianthe and reporters with their sloppy use of the term “brain death?”

If they wonder why Ianthe Livadas doesn’t trust them, they might start looking for explanations with the use – or misuse – of the term “brain dead” in regard to her mother. –Stephen Drake