Looking for traction on the slippery slope: a discussion of the Michael Martin Case.

Case History of Michael Martin The Accident and Michael's Resulting Condition On Friday, January 16, 1987, at about 5:20 p.m., a car/train accident occurred in the town of Moline, Michigan, south of Grand Rapids. Michael Martin, age thirty-five, sustained a severe brain injury. His daughter Melanie, age seven, was killed. Michael's wife, Mary; his daughter Mindy, age eleven; and his son Matthew, age five, all received injuries from which they have in general recovered. For the first several months following the accident, Michael showed little awareness of his surroundings; indeed, a treating neurologist diagnosed him as being in a condition of persistent unconsciousness. Michael's family, however, noticed signs of responsiveness that gradually increased. From 1987 through 1990, Michael was housed first at an acute care facility, then at several rehabilitation facilities, first in the Grand Rapids area and then in the Detroit area. Early on, Mary was appointed as Michael's guardian. In 1988 one of the nursing homes filed a complaint with the Michigan Adult Protective Services against Mary for attempting to stop routine treatment of Michael for pneumonia. Mary reluctantly agreed to provide the needed antibiotics, but from that time forward she refused to allow Michael's sister, Pat Major, and his mother, Leeta Martin, to have direct access to any information about Michael. In 1990 Michael was transferred to the Neurologic Center, a rehabilitation facility in Howell, Michigan. He remained at the center for the next two and a half years, except for brief stays at acute care facilities. In 1990 the Neurologic Center set out to determine Michael's level of cognitive functioning and whether he might be a candidate for an augmentative communication device. He was unable to talk but had some use of his right arm and leg and could pinch the fingers on his right hand upon command. The center retained a neuropsychologist, Dr. Walter Zetusky, who is educated and experienced in cognitive assessment of persons with mental impairments. Dr. Zetusky's 1990 findings concurred with those of an earlier neuropsychological evaluation in 1988: Michael demonstrated good potential for assessing information and thus was a candidate for a communication device. In addition, by performing a series of tests, Dr. Zetusky established that Michael had an IQ of sixty-three, and he opined that because of "scatter" Michael's IQ might be as high as seventy-seven. Michael successfully used the communication device throughout his stay at the Neurologic Center. His access to the device ceased, however, when Mary transferred him to the Glenwood Christian Center in January of 1993, where he presently resides. For the most part, Michael remains physically dependent. He is able to move his right leg, has pinching ability in his right hand, can lift his right arm, and can move his head. Michael smiles frequently, and he has demonstrated the ability to show pain, frown, and even cry. Michael is cooperative, indicates his desire to participate in therapy, and enjoys participating in various recreational activities.(1) He relies on a feeding tube in his stomach for nutrition and hydration but does not require any other medical treatment or care. Butterworth Hospital Incident In january of 1992, without notifying other family members, Mary transferred Michael to Butterworth Hospital in Grand Rapids because he had intestinal blockage. At that time, also without notice to the rest of Michael's family, Mary took steps to have Michael's feeding tube withdrawn. Two doctors at Butterworth concluded that Michael's cognitive level was only slightly above persistent unconsciousness, since in the hospital he demonstrated nothing more than a few eye blinks and a capacity to turn towards sound. Based on that diagnosis, the hospital's bioethics committee agreed that withdrawal of Michael's feeding tube would be appropriate from a medical-ethical standpoint. …