Alice Anderson is a 47-year-old homeless woman who says she would rather die than face surgery to remove her gangrenous feet. If she doesn't have the operation, doctors say, she probably will not live much longer.
The dilemma faced by Anderson as well as the attorneys representing her and St. Elizabeths Hospital, where she is a patient, was spelled out yesterday in a hearing before three judges of the D.C. Court of Appeals.
The judges were considering an appeal by Anderson's court-appointed attorney of a decision Tuesday by D.C. Superior Court Judge Cheryl Long to appoint a guardian to make medical decisions for Anderson.
That decision was based on the Health Care Decisions Act, a District law that went into effect in October 1989. The D.C. Council passed the bill in response to situations similar to Anderson's in which health care decisions have to be made for those judged incompetent.
The appeals panel also was considering whether the guardian, Patrick J. O'Brien, could order the surgery performed. O'Brien told the court yesterday that he would order the surgery if given the chance.
The three-judge panel decided yesterday that the case should be returned to Long so she could consider an opinion by Howard University Hospital psychiatrist Alyce Gullattee that Anderson was competent to make her own medical decisions.
Anderson's lawyer, Darrel Parker, sought Gullattee's opinion after Long's ruling.
Long also will have to decide whether O'Brien can order the operation without first considering "substitute judgment" -- attempting to determine what Anderson would do if she were competent to make her own medical decisions.
Long is not alone. City officials and judges throughout the nation have grappled with how to provide medical care, including emergency surgery, to homeless people who do not want it. Many of these people are mentally ill, and some eventually are found to be incompetent to make decisions for themselves.
Parker told the judges that nobody is certain that the woman now sedated at St. Elizabeths Hospital is really named Anderson, and whether anything else she has told officials concerning her personal life is accurate. But he is sure that she does not want the operation.
"I will not have my feet amputated because of the fact I believe my fate should be left up to God and not to surgeons," Parker quoted Anderson as telling him.
Appeals Court Judge Frank Schwelb said during the hearing, "What a staggering thought, to amputate the feet of someone who doesn't want it to happen."
O'Brien said in an interview that Anderson was found about two weeks ago near the Ellipse. He said that she was not wearing socks or shoes, and that the temperature that day was freezing.
He said she was taken to George Washington University Hospital, where she refused treatment for her feet, which showed signs of gangrene, tissue decay caused by a loss of blood supply. She was then transferred to St. Elizabeths for mental evaluation.
Court testimony indicated that the doctors at St. Elizabeths at first diagnosed Anderson as paranoid-schizophrenic. Later she was judged to have religious delusions.
Parker argued in court that William Daniels, a doctor at St. Elizabeths, could not accurately determine Anderson's condition because she refused to talk to him. Parker said Anderson viewed Daniels as an "antichrist" and part of a satanic conspiracy against her.
Daniels testified at an earlier hearing that surgery was necessary by Feb. 12 to avoid "more extensive amputation of the limbs, infection and quite probably death."
O'Brien told the court that he knew of no relatives or friends to ask about Anderson's feelings on surgery.
Late yesterday, Parker, O'Brien and Constance Tuck, the attorney for the hospital, waited for the appeals court decision in a hallway outside the courtroom.
"I've never had a case like this," O'Brien said. "I've never had to decide if someone should live or die."
"There are no winners in this one," said Parker, shaking his head. "If the courts are slow to make a final decision, she dies. If I win my case, she can elect to do nothing and she will die. If her guardian makes the decision, she becomes a homeless woman with no feet."