In re Helga Wanglie.

In this issue, At Law returns as a regular feature of the Report under the authorship of Alexander Morgan Capron, Henry W. Bruce Professor of Law and Medicine at the University of Southern California. A distinguished legal scholar, Prof. Capron served as executive director of the President's Commission for the StudY of Ethical Problems in Medicine and Biomedical and Behavioral Research and has written extensively on issues in bioethics. Helga Wanglie was an active, well-educated woman of eighty-five when on 14 December 1989 she tripped over a rug and broke her hip. With that injury she began successive treatments at a series of acute care, rehabilitation, and nursing facilities, during which she had several cardiopulmonary arrests. For more than a year-from 23 May 1990, when she suffered severe anoxia, until 4 July 1991, when she died-Mrs. Wanglie lay unconscious in a persistent vegetative state (PVS), her breathing sustained by a respirator and her nutrition supplied through a tube. This sort of extended dying has regrettably become an all-too-familiar tale in our courtrooms. Many judges have been called upon to approve the decisions of seriously ill patients' next of kin to withdraw life-sustaining procedures. Helga Wanglie's dying also became a court case, but with an unusual twist: when Mrs. Wanglie's husband of fifty-three years refused to consent to the withdrawal of her treatment, a Minnesota district court judge was asked to name another guardian in his place. The petition to replace the guardian was filed by Steven B. Miles, a gerontologist who served as an ethical consultant to Mrs. Wanglie's physicians at the Hennepin County Medical Center (HCMC). On 1 july, judge Patricia L. Belois ruled that Miles has offered no evidence that Oliver Wanglie is incompetent to discharge the trust as Conservator of the Person of his wife. "Judge Belois therefore denied Dr. Miles's petition and granted the petition filed by Mr. Wanglie, who the judge found was "the most suitable and best qualified" among available guardians. The narrow, fact-based nature of Judge Belois's decision, coupled with Mrs. Wanglie's death three days later, might seem to render the case of interest only to those directly involved. Yet the dramatic statement by the physicians, when they first announced their intention to go to court, that they did not "want to give medical care they describe as futile,"(1) secured the dispute a lasting niche in bioethics lore as the case that made medical futility front-page news. Since the issues implicated will survive longer than Helga Wanglie did after the court ruled in her husband's favor, it is important to be clear about what really was-and wasn't-involved. The case turns out to be a murky glass for viewing the issue of futility. What Did She Want? Before futility emerged as a full-blown issue at Helga Wanglie's bedside, another issue was in dispute: what views had she held about life-prolonging treatment under the circumstances? Physicians at HCMC have asserted that prior to December 1990, when they pressed Mr. Wanglie to allow treatment to be withdrawn, he told hospital staff that his wife had not discussed these issues, and that her wishes were a 'black box."(2) The implication is clear. Oliver Wanglie knowingly or unknowingly prevaricated; continuing life-support was merely his wish, not a view his wife ever voiced.(3) The astonishing aspect of this case-especially the insinuation from HCMC physicians that their uncertainty about Helga Wanglie's wishes was her husband's fault-is that she was still competent while being treated at HCMC for the first four months of 1990. If the attending physicians at a leading hospital like HCMG-with a long-standing ethics committee and several nationally known ethicists on staff-fail to engage patients like Mrs. Wanglie in discussions about their treatment wishes, then one clear implication of the case is that the Patient SelfDetermination Act may indeed be beneficial. …