An Alexandria judge ruled yesterday that a 72-year-old hospital patient must be allowed to remove himself from life-supporting equipment, even though that "will surely result" in the patient's death.
The ruling by Circuit Court Judge Albert H. Grenadier, believed to be unprecedented in Virginia, will permit Andrew McLellan, an AFL-CIO official who has been intensive care at Alexandria Hospital for more than two months, to be disconnected from a dialysis machine and go home.
"His wish is to get out and go home and die in his own bed," said Michael Boggs, a longtime colleague and friend of McLellan, who joined McLellan's family and friends in praising the judge's order.
Grenadier dismissed a petition by the hospital seeking to prevent McLellan and his wife, Gloria, from removing McLellan from the life-sustaining kidney dialysis machine. The hospital argued that neither was capable of giving informed consent to withdrawal of the treatment. At a hearing last Thursday, the judge heard McLellan's family and friends support his wish.
Grenadier ruled that McLellan was "legally competent and sufficiently informed" to make a decision to discontinue medical treatment, although "to do so will surely result in his death. . . .
"It is the opinion of this court that Mr. McLellan has the legal and moral right to make this decision. He has the unfettered right to control his own destiny. A competent, adult patient has the right to refuse treatment for himself. . . . In this case, the Court is of the opinion that the state's interest in preserving life, protecting innocent third parties, preventing suicide and maintaining the ethical integrity of the medical practice is overborne by Mr. McLellan's constitutional right of privacy and his right to individual free choice and self determination."
Alexandria Hospital attorney C. Torrence Armstrong said he believes the ruling establishes "a liberty that has had relatively little precedent. Virginia has not had an opportunity to squarely address that." Armstrong also said there would be no appeal of the judge's decision.
According to Boggs and others familiar with the case, McLellan, who has emphysema, has been in the intensive care unit of Alexandria Hospital since early November with complications resulting from abdominal surgery.
Boggs said McLellan is unable to speak, but is lucid and has silently mouthed the words "I want to be unplugged, I want to get out. I want to go home."
Jeff Stryker of the President's Commission for the Study of Ethical Problems in Medicine yesterday described McLellan's case as rare, saying that "the Karen Ann Quinlan situation," where the patient is not competent to decide medical treatment, is more frequent. He added that although there are no laws that deal with McLellan's case directly, "under the general doctrine of informed consent, a patient has control over his own body."
One case cited by Judge Grenadier involved an elderly Florida man with amyotrophic lateral sclerosis (also known as Lou Gehrig's disease), whose wish to turn off his respirator was eventually upheld by the Florida Supreme Court.
Ten states plus the District of Columbia have adopted so-called "natural death acts" allowing people to draw up documents instructing physicians on the circumstances under which their treatment is to be continued if they become incompetent to make further decisions. Neither Virginia nor Maryland has enacted such a law.
McLellan's wife said yesterday, "I am not physically able to talk about it--to go into physical details. . . " of her husband's illness. She said she thinks the judge's ruling is "an important decision and can do an awful lot of good for an awful lot of people in the future."
Mrs. McLellan was making arrangements yesterday to have her husband moved home with a respirator.