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NJ Case May Decide if Hospitals Can Pull the Plug on Vegetative Patients

The Appellate Division of the New Jersey Superior Court heard arguments on a controversial bid by Trinitas Hospital to establish a right to pull the plug on a patient in a persistent vegetative state against the wishes of family, including a court-appointed guardian. The case might have been dismissed as moot since the patient, 72-year-old Ruben Betancourt, died pending appeal, leaving the court no live case or controversy to decide. But the hospital’s lawyer persuaded the court to hear arguments and take briefs to decide whether the prospect that similar circumstances may arise in the future warrants a decision on the merits.

Betancourt’s family obtained a restraining order in March 2009 to preclude Trinitas from withdrawing life support.

At least one member of the three-judge panel seemed disinclined to make a ruling on the merits. The presence of additional lingering disputes, including a hospital bill in excess of $1.6 million and a prospective malpractice case, might be good reason to refrain from using this case to make a ruling on who has the ultimate right to pull the plug, Judge Philip Carchman suggested.

The case drew a large amount of interest, including submission of friend of the court briefs by several disability rights groups who fear a ruling in the hospital’s favor would result in patient care being discontinued for cost reasons.

If the court decides to explore the case based on its merits, a 1987 New Jersey Supreme Court ruling upholding a patient’s right to determine his own treatment could mold the court’s decision. In that case, it was the doctors who wanted to continue treatment over the objections of family members of a patient in a vegetative state.

Persistent vegetative state is a rare medical condition affecting less than 200,000 people in the United States, according to the National Institutes of Health. In 1994, the New England Journal of Medicine acknowledged recovery of consciousness from a persistent vegetative state was possible, though unlikely, after 12 months if the state is trauma induced, and exceedingly rare after three months in nontraumatic cases.

In 2010, the same journal released a study in which MRIs demonstrated some awareness among 23 patients in a persistent vegetative state, including one who could answer yes-or-no questions. Such advancing medical knowledge would make a ruling in the hospital’s favor unlikely, especially in light of the New Jersey precedent establishing the patient’s right to determine care. Though the doctors might believe further treatment to be futile in a given case, allowing them to pull the plug in the face of medical research showing recovery to be possible would effectively sanction nonconsensual euthanasia.