End-of-Life Decisions: What If It Happens In Your Family?

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The Tighe family's fact-finding mission was relatively straightforward. Three years ago, Jimmy Tighe, then 48, of Cleveland, Ohio, fell down some stairs at his father's house and was knocked unconscious. The ambulance crew accidentally threaded a breathing tube into his stomach, leaving him without oxygen for the 12-minute ride to the hospital. When his brothers were told three months later that Tighe was in a persistent vegetative state, they mentally replayed conversations they had had about death four years earlier, after another brother had been shot and killed. "We all said, 'Don't put us on any life support,'" says Keith Tighe, 41. "Jimmy said it too." Still, it has taken time for the Tighes to act, as is often the case. Only in February, after Jimmy developed pneumonia, did the brothers and their father move him into a hospice and start the procedural steps required by the center before a feeding tube can be removed. In the meantime, the Tighes visit Jimmy every day.

Relatives often need time to sift through intense feelings and to say a long goodbye. Last September the family of Jill Rudolph, 41, of Toledo, Ohio, voted 5 to 3 to remove her feeding tube. She had been in a persistent vegetative state since May, when she suffered multiple strokes. Her mother Joyce Moran voted against removal. Years ago, Moran's brother-in-law had needed six months to emerge from a coma; what if Rudolph needed that time too? The family compromised, agreeing not to take immediate action. But by November, Moran had gone through an intense period of prayer, research and discussion with the doctors and her priest. On Nov. 8, doctors removed Rudolph's feeding tube but kept her on morphine. She died on Dec. 4. "My priest advised me to do the loving thing," says Moran.

Such trials can sometimes bring families closer. Marianne Svanberg, 88, a Swede, suffered a massive stroke while visiting her granddaughter Kim Gagne in Santa Rosa, Calif., in January, setting off a bitter generational row between Svanberg's daughters and granddaughters about whether to put her on a feeding tube. At one point, recalls Gagne, 40, "my mother and I had a big blowup, right there in front of the doctor." The granddaughters prevailed, and a tube was inserted, but Svanberg's condition worsened. She died on Feb. 19, leaving a family that was mournful, says Gagne, but knit tighter and united in the belief that it was right to have given Svanberg a chance to recover. "Even the aunt who was hardest on me has become a friend," Gagne says.

Then there are cases like that of an Iowa social worker who had guardianship over her mother, who was in a persistent vegetative state following a reaction to iodine. After three years, the woman and her sister agreed to remove their mother's feeding tube, but they did not inform their aunts for fear the women would try to stop them. "To this day, they don't really talk to us," says the social worker.

The burdens on a family are significantly reduced when the patient has made decisions in advance--for instance, choosing a surrogate to act on his or her behalf by filling out a durable power of attorney for health care. A living will, also known as an advance directive, helps a proxy understand the patient's wishes--and "avoids the suspicion that a family is doing something for ulterior motives," notes Prager.