ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Thursday, November 21, 1996 TAG: 9611210033
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: LAURENCE HAMMACK STAFF WRITER
EVEN IF SHE RECEIVES blood transfusions, they may not save the woman whose family is fighting for her life. The hospital says it can only carry out the patient's own express wishes.
As Doris McDaniel lay close to death Wednesday in a hospital bed, a Roanoke judge authorized doctors to give her a blood transfusion - despite her earlier objections based on her religious beliefs as a Jehovah's Witness.
In an unusual case in which medical ethics clashed with the wishes of a patient's loved ones, McDaniel's family asked Judge Robert Doherty to issue an emergency order allowing Carilion Roanoke Community Hospital to administer what could be life-saving transfusions.
McDaniel, 72, had signed papers during her stay at the hospital for surgery stating that for religious reasons she did not want to receive transfusions.
In asking Doherty not to grant the order, the hospital on Wednesday stood by McDaniel's wishes - even though family members maintained that she had a change of heart once it became clear she was facing death.
McDaniel's husband of 53 years, Richard, testified that on Nov. 7 his wife nodded "yes" from her bed when he asked if she would accept a transfusion. Hospital officials contended that McDaniel - who was sedated, unable to speak and on a ventilator at the time - was unable to make an informed decision.
"A patient's wishes have to be respected, even if the patient has become incapacitated after expressing those wishes," Elizabeth Schell, associate general counsel for Carilion Health System, said during a hearing in Roanoke Circuit Court.
But the hospital's argument that it was ethically bound to honor McDaniel's request was lost on her family.
"A hospital is supposed to save lives, not take lives," Richard E. McDaniel said. "If they let her die without the blood transfusion, it's legal murder."
McDaniel's daughter, Doris Thompson, said she was particularly galled by the hospital's defending its position on ethical grounds.
"I feel like it's unethical for them to stack so many people against a small family," Thompson said. "We're trying to save our wife and our mother, and they're trying to take her away. I don't think that should be their call to make."
Doherty took time away from a jury trial he was presiding over Wednesday to hear the case. The hearing was hastily arranged after Roanoke lawyer Jack Altizer rushed to the courthouse with a request for an emergency order. He was hired by the McDaniel family earlier this week.
"I think it's a question of balancing the value of life against a particularly irrational religious belief," said Altizer, "and thank God the wisdom of the law was able to triumph in this case."
Several hours after Doherty's mid-afternoon decision, McDaniel had not yet received the transfusions. Hospital officials, who were considering appealing the judge's ruling, emphasized that it did not require them to give McDaniel blood.
Instead, they said the judge's order merely gave them the option of overriding the patient's wishes.
Earlier this year, McDaniel was admitted to Community Hospital for what was believed to be a cancerous colon. After discovering that she had a chicken bone lodged in her colon, doctors removed it surgically.
A short time later, doctors had to operate on McDaniel a second time to remove a crimp in her colon that was detected after the first procedure. McDaniel signed at least five forms in which she said she did not want to receive blood transfusions, and made other statements to that effect, according to testimony Wednesday.
Richard McDaniel, who says he does not share his wife's religious beliefs, had earlier questioned her decision not to accept blood.
"We had argued about that quite a bit," he said. "She's kind of hard-headed; the more you argue with her about something, the least likely she is to go along with it."
Many Jehovah's Witnesses refuse blood transfusions on religious grounds based on biblical passages urging people to "abstain from blood" (Acts 15:28). Among them is Leviticus 17:10, which reads: "Whatsoever man ... eats any manner of blood, I will cut him off from among his people."
When it became clear his wife needed blood to live, McDaniel said, he asked her again in her room in the intensive care unit, shortly after she suffered complications from her second surgery. At that point, he said, she nodded her head.
McDaniel said doctors and nurses balked at his requests to follow up on McDaniel's apparent change of heart. In what became the defining issue in the case, the hospital contended Doris McDaniel was no longer competent to make such a decision.
Although the issue has not been addressed by the Virginia Supreme Court, the hospital presented court cases from other states supporting its position - which was also backed by the American Medical Association's Code of Ethics.
"I think one of the fundamental tenets that has developed in the last 20 years of medical ethics is the notion that a patient who is capable of making their own decision has the right to refuse any treatment - including life-sustaining treatment," said Charles Hite, Carilion's director of biomedical ethics.
Hite declined to comment on the details of McDaniel's case, but spoke about the general issues it raises.
When a patient decides to forgo treatment and later becomes incapacitated, the hospital contended, doctors are bound by the patient's wishes at the time he or she was deemed legally competent to make a decision.
"Otherwise, informed consent is very hollow," Hite said. "If you are able to override a patient's clear wishes simply because they have become incapable of speaking for themselves, then you have really eroded a fundamental patient's right."
In making his decision, Doherty said he felt that neither the hospital nor McDaniel's family was wrong. "I recognize the family's feelings and I recognize the biomedical ethics, and I don't find fault with either one of them," he said.
But in deciding to grant the order, Doherty gave more credence to the family's beliefs that McDaniel was competent to change her mind Nov. 7. That conflicted with expert testimony from doctors, the judge conceded.
"But family members are experts in family matters," he said, "and certainly the doctors could have no more expertise about this woman's feelings than someone who has lived with her for 50 years."
Although the family prevailed in court, there was no assurance that blood transfusions would save McDaniel's life. She was listed in guarded but stable condition Wednesday night.
"I hope this lady recovers," Altizer said, "and I hope that some day she will be able to walk into my office, give me a big hug and say: 'Thank you for saving my life.'''
But McDaniel's granddaughter, Cathy McDaniel, said not all family members support the legal action. She said her grandmother was adamant about not wanting a blood transfusion, and carried a card with her at all times stating her wishes.
Even now, Cathy McDaniel believes, her grandmother's decision would be the same - if only she could voice it..
"To me," McDaniel said, "if she's going to die soon, at least let her go with some dignity."
LENGTH: Long : 129 lines ILLUSTRATION: PHOTO: CINDY PINKSTON\Staff. Richard E. McDaniel said his wifeby CNBfinally agreed to accept blood transfusions. Shown with him in the
hospital are his daughters Doris Thompson and Jerri Conner. color.