John Jackson, a 78-year-old Northeast Washington man, had an abnormal fear of doctors. Two weeks ago when he was told that his leg had to be amputated or he would die, Jackson refused the operation. "If you let them," he told his nephew, "doctors will cut your head off."
Doctors at D.C. General pleaded with the elderly diabetic man to let them proceed with the operation. But Jackson, whose brother had died of the same operation, was adamant. "Don't bother me," he told them, "you're not going to touch me."
Then Jackson slipped into a coma, leaving doctors in a quandary. They calculated that without the operation he had about 12 hours to live. However, they could not operate without his consent. Finally, the doctors called D.C. Superior Judge Robert M. Scott who at 10 p.m. on Oct. 17 convened an unusual hospital hearing several yards from Jackson's bed.
Scott sat with his legs dangling from a hospital examination table in his makeshift courtroom. He listened as an attorney appointed to represent Jackson argued that Scott should permit the surgery so Jackson would not die.
Then, at 4 a.m., the judge, declaring that "each man has the right to his own destiny," ordered surgeons not to proceed with the operation.
The unusual ruling -- which hospital officials said marked the first time a judge had not permitted them to proceed with a life-saving operation -- was appealed in another pre-dawn court hearing several hours later at the D.C. Court of Appeals. Judge Catherine B. Kelly, awakened at her home by Jackson's attorney, agreed to an immediate 6 a.m. court session, and reversed Scott's decision. The lawyers immediately rused back to D.C. General carrying a written order permitting the surgery.
This is a story of what happens when the wheels of justice cannot be slow, and when judges and lawyers -- hampered by the pressures of time -- must get out of bed and take their courthouse with them. In this case, the judges also faced the awesome task of weighing a man's free will against a doctor's oath to save a life.
Jackson had first been informed about the gangrene spreading through his leg in early October at the Washington Hospital Center, where he had stayed for several weeks. He refused to be operated on there. After family members transferred him to D.C. General, he again refused the operation and slipped into a coma.
Jackson's doctor at D.C. General, Robert Vaughn, said his first instinct was to operate anyway. "That's what we're all about -- saving lives," he said in an interview.
But because several of Jackson's family members were opposed to going against his wishes, Vaughn decided he had best obtain a legal determination. He contacted the city's highest legal officer, D.C. Corporation Counsel Judith W. Rogers.
Rogers called Scott, who was assigned as the "emergency judge" that night, and the judge rushed to the Surgical Intensive Care Unit of D.C. General.
Scott set up court in a dimly lit examination room near the nursing station.
He was presented with Jackson's medical chart. Scott was joined by Rogers and a D.C. lawyer, Scott Blake Harris, who was asked to familiarize himself with the case and represent the comatose Jackson.
The three worked feverishly into the early morning. They telephoned as many of Jackson's family members as they could find, with the judge swearing them in over the phone. During five hours of testimony, the relatives were asked whether they thought Jackson was sane when he refused the operation.
Two of Jackson's elderly sisters, roused at 3 a.m., said their brother had been mentally deranged as a result of a back injury some years ago and was afraid that doctors would kill him. They also said that Jackson's brother had once been operated on for the same problem and had died without leaving the hospital. So when they tried to convince Jackson now to undergo the amputation, he "acted as if he didn't hear."
Their brother, one of the sisters said, would probably still refuse the operation because he's "God-afraid of doctors."
Another relative, Jackson's 40-year-old niece Sarah Campbell, was reached at 3:45 a.m. She testified that Jackson appeared very depressed recently at the Washington Hospital Center, with "tears in his eyes."
When she asked him how he felt, Jackson replied: "Pretty good, thank the Lord, [but] you got a right to be worried about me if I'm in this hosptial."
None of Jackson's relatives had been able to convince him to undergo the surgery, and most were sure he would continue to refuse were he not in a comatose state.
After taking the telephone testimony, Scott and the lawyers adjourned to a tiny examining room at 3:48 a.m. They were very aware of the time. Jackson's life lay in their hands. Vaughn stood in the doorway. Scott, preparing to make the lonely decision judges often make, sat with his legs dangling from a hospital examining table, and turned on a cassette recorder to tape the legal arguments. Harris leafed through his yellow legal pad preparing his legal arguments for the extraordinary court hearing.
Harris argued that Jackson's refusal to undergo the amputation of his leg was not based on any religious beliefs. Instead, he said, it was based on an extreme fear of hospitals, one that was so great that Jackson had not made a rational decision or understood the consequences. Therefore, Harris said, doctors should be allowed to operate on the comatose man. "If we decide not to let the operation go forward," Harris said, "we decide that this man dies."
"You don't decide that," Scott said gruffly, his face matted in sweat. "I do."
Then Scott issued his ruling. "Each man has the right to make his own destiny," he said slowly. "I am satisfied [Jackson] was of sound mind and rational and could make a decision.
"I am also satisfied that he knew what the result would be if he made the decision not to have the operation -- that death would ensue. His brother had died of this. He didn't want to be operated on. Many a person has a terrible fear of an amputation. I have heard people say that 'I would rather die than be without a limb.' This is not an unreasonable choice. Accordingly, I will not give the permission to the hospital to operate."
It was 4:15. "Doctor, I will not give you permission to proceed."
"I understand," Dr. Vaughn replied.
With the clock on Jackson's life still ticking, Harris decided to immediately appeal the case to the D.C. Court of Appeals, the city's highest court. Harris and Rogers awakened appellate Judge Kelly at her apartment shortly after 4:30 a.m. She agreed to meet them at the courthouse at 6 a.m. for an immediate hearing on the case and Rogers and Harris rushed there.
They met Kelly in her chambers. She reviewed the notes taken from conversations with Jackson's family members, and listened to Harris' arguments. Within half an hour she ruled that Jackson should be operated on against his request in order to save his life, reversing Scott's emergency-room decision.
The attorneys quickly called Dr. Vaughn. He said he would meet them at the hospital and asked them to bring a written order so the doctors could proceed.
The two exhausted attorneys dashed across town again. By now the sun was up and they spotted Vaughn and rushed toward him in the chilly morning air. But Vaughn motioned sadly that they were too late.
Before he made it to the operating table, John Jackson had died.