Recovery from persistent vegetative state? The case of Carrie Coons.

Recovery from Persistent Vegetative State?: The Case of Carrie Coons How reliable is a diagnosis of irreversible unconsciousness? In a unique case in New York, a state Supreme Court judge vacated an order allowing removal of life-sustaining treatment after Carrie Coons showed signs of recovery from a diagnosed vegetative state. On April 9, 1989, Carrie A. Coons, an eighty-six-year-old Rensselaer, New York woman who had been diagnosed as being in a persistent vegetative state (PVS) regained consciousness, took small amounts of food by mouth, and engaged the next day in conversation. Only days before, a judge had granted her family's request that the feeding tube keeping her alive be removed. Mrs. Coons's unexpected recovery has left her doctor and family baffled. Medically, this case raises questions regarding the reliability of a diagnosis of irreversible unconsciousness. Legally, it raises questions regarding when, and on what basis, life-supporting treatment may be discontinued. Mrs. Coons had a massive stroke in late October 1988. Initially, she had done well, but her condition deteriorated in late November. She suffered a major brain bleed, and entered a vegetative state, which persisted for several months. During that time she neither spoke nor showed any signs of alertness. She was able to breathe on her own, but could not take food orally. A gastrostomy tube (g-tube) was surgically inserted to give her fluids and nutrition; a computerized tomography (CT) scan and electroencephalogram (EEG) supported the clinical diagnosis of persistent vegetative state. In late January 1989, Mrs. Coons's sister, Edith I. Gannon, with whom Mrs. Coons had lived, asked that the feeding tube be removed. She maintained that her sister never wanted to be kept alive in this condition. Dr. Michael L. Wolff, a gerontologist and nationally recognized specialist in geriatric medicine, was asked to evaluate the patient. Dr. Wolff suggested having another scan to confirm the diagnosis of PVS. He also thought that a scan might reveal hydrocephalus, in which case Mrs. Coons might need a shunt to drain fluid from her skull. The family expressed to Dr. Wolff their feeling that further procedures at this time were unduly invasive and unnecessary. Had they been offered a second, confirmatory brain scan in November, when they still had hope for her recovery, they would have willingly agreed. Under the present circumstances, Mrs. Gannon absolutely refused to consent to an operation. She asked Dr. Wolff not to perform any more tests, not to call in any more consultants, but just to "let my sister be." In March 1989, relatives testified at a hearing that for fifty years before her stroke, Mrs. Coons had expressed a desire not to be kept alive artificially. Dr. Wolff testified that the family had refused consent for a shunt, and that he agreed that a shunt would not be in accord with prevailing medical standards. He told the judge the Mrs. Coons had been in a vegetative state for four and a half months, and that, in his opinion, her condition was irreversible. State Supreme Court Judge Joseph Harris ruled on April 4, 1989 that the tube could be removed, allowing Mrs. Coons to die. This makes Mrs. Coons the first New Yorker for whom a right-to-die petition was approved since the state's highest court, the Court of Appeals, authorized in 1988 the removal of feeding tubes in cases in which the prior wishes of an incompetent patient could be proved. However, Mrs. Coons unexpectedly regained consciousness, apparently as the result of aggressive efforts by the nursing staff to stimulate and feed her. When Dr. Wolff visited Mrs. Coons on Monday, April 10, he explained that with a feeding tube, she could probably live two or more years. Without it she could die in two weeks. When asked what she wanted done, she replied, "That's a very difficult decision to make." Dr. Wolff telephoned the family's lawyer, Charlotte Buchanan, to alert her to the change in Mrs. …