Judge rejects woman's choice of 'death over dialysis'Sunday, 04 July 2010 08:24 Jerry DeMarco
ONLY ON CLIFFVIEW PILOT
Valley Hospital officials didn’t care whether one of their patients refused life-saving dialysis: They were not going to let her die. So they got a court order -- and now, five months later, the woman is alive and thriving. The case resembles others in which a judge had to make a life-or-death decision whether or not to limit an individual's right of self-determination.
“In a situation where the hospital's own psychiatrists disagreed as to [the patient’s] mental capacity,” wrote Superior Court Judge Ellen Koblitz out of Hackensack,
The Valley Hospital in Ridgewood “sought the appointment of a special medical guardian to consent to life-saving dialysis treatment.”
Her doctor told the judge his patient was “was overridden with a fear of the dialysis machine, partially because, in her view, machines that duplicate bodily functions overly intrude into God's domain.”
Koblitz, in turn, determined the woman “was incompetent to refuse dialysis treatment because she denied that she would most likely die without dialysis.“
She’ a 42-year-old Jamaican home health aide, with an eighth-grade education, who was admitted to the hospital in late January with “end-stage renal disease, hypertension, uremia, anemia, and lupus.” She was short of breath and had other symptoms of anemia, requiring a blood transfusion, court papers show.
Physicians at The Valley Hospital immediately determined that the woman -- identified in court papers as J.M. -- would die without dialysis, court papers show.
But she resisted.
“[A]ccording to her,” wrote Koblitz, the chief Chancery judge in Bergen County, “God would cure her kidneys and prevent her from dying.”
The woman had rented a house in Hawthorne for $1,000 per month to give her son “a better school situation,“ court papers say.
She “relied on her hourly wage of $10 to $15 per hour to support herself and her son and understood that she had an insufficient work history to qualify for Social Security Disability should she be unable to work.
“J.M. was a devout Christian who carried the Bible with her and attended services regularly,” the judge wrote. “Her pastor spoke to her in the hope of convincing her to accept dialysis treatment, but was unsuccessful.”
In early February, the hospital filed a complaint in the Chancery Division of Superior Court in Hackensack seeking the appointment of a special medical guardian.
According to court records: “An affidavit from Dr. Mikhail Kotlov, M.D., [the woman’s] treating board-certified nephrologist, indicated that treatment was necessary to save [her] life.“ Unfortunately “no alternative to dialysis was available,” it says.
J.M. had only a 17-year-old son and no health care directive. She “was generally aware of the situation and refused dialysis treatment, contrary to medical advice,” Koblitz wrote.
Seeking fairness and justice, she appointed attorneys for both sides. Various experts testified and submitted affidavits. Among those called were the assistant pastor of the woman’s church and hospital social workers.
J.M. was able to listen to all of the proceedings “over the phone from a hospital room,” Koblitz noted in her ruling.
The guardian’s role was to “act as ‘eyes of the court‘ and further the best interests of the patient, even if those interests may differ from what the alleged incapacitated person wants,” the judge wrote.
“J.M. was in irreversible kidney failure,” court papers show. “The glomerular filtration rate (GFR) places a value on the function of the kidney, with normal function being between one hundred and one hundred twenty. If the GFR is less than ten, a person should undergo dialysis.
“J.M.’s GFR was at one,” the report adds, “indicating she was in dire need of treatment.”
Although she’d received dialysis in the past, J.M. wasn’t budging this time.
“Her condition was critical,“ her doctor wrote, “and without treatment she would die over time.”
Dr. Dealwis, the board-certified director of psychiatry at Valley Hospital, agreed that J.M., although depressed, did not want to die.
“Her refusal of dialysis was based upon her conviction that God had spoken directly to her and would save her, which Dr. Dealwis considered to be a delusional belief,” Koblitz wrote in her decision.
The doctor said she’d reported suffering from tuberculosis and lupus, “but Jesus cured her. The reason her kidneys had not healed,” the doctor said, “was because of Satan’s intervention.”
A dissenting physician suggested that J.M. had a “different perspective afforded a doctor dealing with terminally ill patients, who are generally allowed unlimited authority to refuse treatment.”
Finally, the day came that J.M. testified for herself.
She told the judge she attended a Christian Pentecostal church every Wednesday for over two hours and again on Sunday for one or two services.
“She prayed frequently and always kept a Bible with her,” Koblitz repored the woman saying.
Working as a certified nursing assistant and home health aide she “had come into contact with elderly
people undergoing dialysis,” the judge wrote. “She testified that they seem tired and drained after dialysis and she did not want to be like that.
When Koblitz asked her point-blank whether she understood the consequences of her decision, the woman responded: “I understand what they are saying to me . . . I’m going to die, and I say I shall live and not die.”
Two of the three physicians who testified said J.M. “demonstrated anxiety, depression, and an inability to problem-solve.” She “did not believe she would die if not treated, and therefore, was not making a reasoned decision to choose death over dialysis.”
New Jersey law recognizes a competent adult’s right to refuse life-saving medical treatment under both the right of privacy under the United States Constitution and the common-law right of self-determination.
“If a patient is not able to understand the consequences of the decision, however, that patient is unable to give informed consent and is therefore incapacitated,” state law says.
“J.M.‘s refusal of treatment was not premised upon an established tenet of her religion precluding certain medical
procedures, as evidenced by her consent to all other medical treatment and her pastor’s attempt to convince her to undergo dialysis,” Koblitz said.
“As a result, her belief that God would save her does not preclude her from being found incompetent, nor does the appointed guardian need to act on that professed belief.”
The day after the judge‘s ruling, “J.M. had a dialysis treatment and was reported to be feeling better,” Koblitz wrote proudly -- noting that the woman has chosen not to appeal the court order.
http://www.cliffviewpilot.com/bergen/1432-judge-rejects-womans-choice-of-death-over-dialysis
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