Opinion ID: 1985823
Heading Depth: 1
Heading Rank: 2

Heading: Court of Chancery Hearing

Text: It is undisputed that Mrs. Tavel never executed a living will that expressed, in the event of her incapacity, her wishes concerning life-sustaining treatment. Accordingly, the Court of Chancery conducted an evidentiary hearing with regard to Mrs. Tavel-Lipnick's petition to remove the feeding tube from her mother. The hearing took place on March 3, 1995. At the hearing, Mrs. Tavel-Lipnick presented the testimony of several friends and acquaintances of Mrs. Tavel in support of her petition. Mrs. Tavel-Lipnick also presented the testimony of Alan J. Fink, M.D. (Dr. Fink) concerning her mother's present condition and her future prognosis. The attorney ad litem joined Mrs. Tavel-Lipnick in her petition. In opposition to Mrs. Tavel-Lipnick's petition, the State presented the testimony of Italo V. Monteleone, M.D. (Dr. Monteleone). Mrs. Tavel-Lipnick's first witness, Rabbi Peter H. Grumbacher (Rabbi Grumbacher), testified that he had been Mrs. Tavel's rabbi and close friend since 1972. He had periodically visited Mrs. Tavel in the nursing home after her stroke. He said that during none of his visits had Mrs. Tavel ever appeared to relate or respond to him. Rabbi Grumbacher depicted Mrs. Tavel, before the stroke, as a vivacious, charming and funny woman, who possessed a deep faith in her religion. Although he admitted that Mrs. Tavel had never expressed her wishes to him regarding life-sustaining treatment, Rabbi Grumbacher believed, in view of Mrs. Tavel's concerns about her appearance and the quality of her life, that she would not have wanted the feeding tube implanted in the first place, and would now want it removed. He indicated that removing the feeding tube to permit Mrs. Tavel to die would be consistent with the tenets of Reform Judaism. Florence Drooz (Mrs. Drooz) testified that she and Mrs. Tavel had been close friends for a very long time. She had visited Mrs. Tavel twice a week in the nursing home since her stroke. Mrs. Drooz related that on her first visits to the nursing home, Mrs. Tavel would appear to respond to her by speaking incoherently, but that for the past six months to a year she had observed no response from Mrs. Tavel whatsoever. Mrs. Drooz believed, based on her understanding of Mrs. Tavel's friendly and outgoing nature, that Mrs. Tavel would not have wanted to live under the present circumstances in which she is incapable of communicating. Dorothy Beulah (Ms. Beulah) testified that she had worked for Mrs. Tavel for six years. She quoted Mrs. Tavel as once stating, I hope I will never get sick and just linger.... Ms. Beulah admitted that Mrs. Tavel's statement had been vague. Ms. Beulah also acknowledged that Mrs. Tavel had never expressly discussed life-sustaining treatments with her. Mrs. Tavel-Lipnick testified that her mother was the strongest person she had ever known. She asserted that her mother was a person who needed to be in control and was always in control of everything. She had no doubt that her mother would have wanted the feeding tube removed because: [she] would never want to be dependent on anybody for anything that way. My mother would not want to have this invasive thing in her; I mean this tube forcing food into her that she can't even enjoy. She would hate that, because she loved good food.... She loved life, my mother. She was just a very vital person. This would be like ... a nightmare for her. Mrs. Tavel-Lipnick further testified that her mother had made her promise never to let her become helpless and dependent like people they had visited in nursing homes. Mrs. Tavel-Lipnick recalled that she and her mother had at one time discussed Dr. Kevorkian and euthanasia. She testified that her mother had approved of Dr. Kevorkian's actions in assisting seriously ill people commit suicide, specifically referring to his actions as a blessing. Mrs. Tavel-Lipnick had initially visited her mother every day at Ingleside but had subsequently reduced the visits to three times a week. She said that her mother had appeared to recognize and respond to her at first, but that her mother had not responded to her for a long time. She said that sometimes when she called her mother's name, her mother would open her eyes but did not appear to see her. Mrs. Tavel-Lipnick testified that her mother had no property and that there was no question of an inheritance. Jimmy D. Harrington, R.N. (Mr. Harrington), had supervised the nursing care for Mrs. Tavel since September 1, 1993. He testified that when he first began to care for Mrs. Tavel, she appeared to respond to him and that sometimes she would squeeze his hand at his request. When he called her name, he stated that Mrs. Tavel would open her eyes and that her eyes appeared to follow him around the room. In Mr. Harrington's opinion, Mrs. Tavel was initially somewhat communicative, although her speech was distorted and her words were incoherent. Mr. Harrington testified that Mrs. Tavel's condition had progressively deteriorated since he began caring for her. He acknowledged that he had not heard her speak for nine or ten months and that her general responsiveness had diminished significantly. As to her physical condition, Mr. Harrington indicated that Ms. Tavel could not move in her bed but that she could sit in a chair if a nurse placed her there. Mrs. Tavel had no ability to move her left side but Mr. Harrington had witnessed some spontaneous movements on her right side. He testified that Mrs. Tavel suffers from an intermittent persistent cough, seizures, blisters, edema, ulcers and pallor. Recently, Mr. Harrington recounted that Mrs. Tavel had experienced episodic periods of vomiting and had lost a significant amount of weight. Dr. Fink, a neurologist, examined Mrs. Tavel and offered his assessment at the hearing. Dr. Fink opined that Mrs. Tavel's stroke had left her in a coma vigil, a form of persistent vegetative state in which the patient has no ability to perceive or to respond. He defined a coma vigil as a fixed neurological state where the brain is so irreparably damaged that the patient is actually in a coma, but they appear to be awake. Dr. Fink testified that Mrs. Tavel had become permanently quadriparetic, meaning that she had permanently lost the use of her four limbs. In Dr. Fink's view, Mrs. Tavel had no hope of ever recovering. Because a patient in a coma vigil appears to be awake, Dr. Fink explained that people are often misled into believing that the patient's random eye movements signify that the patient is alert and responsive. Furthermore, Dr. Fink testified that a patient in a coma vigil retains the ability to exhibit some reflexive actions, such as grasping or squeezing. Dr. Fink believed that Mrs. Tavel's condition would not cause her death directly but that, in any event, her life expectancy was only six months to a year. Dr. Fink testified that the removal of Mrs. Tavel's feeding tube would cause her to become dehydrated and to starve. He predicted that she would probably die from natural causes within ten to fourteen days after the feeding tube was withdrawn. Dr. Fink testified that Mrs. Tavel would not suffer any pain during that period, however, because Mrs. Tavel's condition left her unable to experience emotion or feeling. The State's expert witness was Dr. Monteleone, a retired neurologist. In Dr. Monteleone's medical opinion, Mrs. Tavel was not in a persistent vegetative state because her kidneys continued to function, her breathing was normal and because she could open and close her eyes. Dr. Monteleone testified that he believed Mrs. Tavel was still capable of some movement because he had pinched her toe and she had moved her leg in response. Dr. Monteleone agreed with Dr. Fink that Mrs. Tavel had no chance for recovery and that her life expectancy was from six months to a year. Dr. Monteleone disagreed with Dr. Fink's assertion that Mrs. Tavel would not suffer any pain if the feeding tube was withdrawn. He stated that it was impossible to tell whether a person in Mrs. Tavel's condition would or would not suffer pain. Dr. Monteleone admitted that he was morally and ethically opposed to the removal of the feeding tube. He acknowledged that his religious beliefs played a part in his medical opinion.