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In re Requena

September 24, 1986

IN THE MATTER OF BEVERLY REQUENA


Stanton, A.j.s.c.

Stanton

Defendant Beverly Requena is a fully competent 55-year old woman who is dying of amyotrophic lateral sclerosis (ALS). Since April 4, 1985 she has been a patient at St. Clare's/Riverside Medical Center (Hospital). Mrs. Requena's ability to swallow will be totally gone in a very short while. She has notified the Hospital that when she has lost the ability to swallow she will refuse to accept feeding by a nasogastric tube or other artificial device. While recognizing Mrs. Requena's right not to accept artificial feeding, the Hospital asserts a strong institutional policy against participating in the withholding of food or fluids from a patient. It has asked Mrs. Requena to leave the Hospital. She has declined to do so. The Hospital has brought this action to compel the patient to leave the Hospital.

ALS is a disease which involves degeneration and hardening of portions of the spinal cord. It is characterized by progressive loss of control of the muscles of the body and by increasing paralysis. There is no cure for the disease. Its course is relentless. Death within a few years of onset is the inevitable result of ALS. Although the victim progressively loses the ability to control bodily movements and functions, his mind typically remains clear until death.

Beverly Requena was first diagnosed as having ALS in February 1985. On April 4, 1985, she became a patient in the Respiratory Rehabilitation Center of Riverside Hospital in Boonton, New Jersey. (In November or December 1985, Riverside Hospital and St. Clare's Hospital in Denville were consolidated into a new entity known as St. Clare's/Riverside Medical Center, Inc., the plaintiff Hospital. The former St. Clare's Hospital was very much larger than Riverside Hospital. The Roman Catholic religious order of sisters which controlled St. Clare's has ended up as the controlling force of the new entity.) Mrs. Requena has been on a respirator since her arrival at the Hospital. Her condition has deteriorated progressively. She is now completely paralyzed from the neck down. She lost the

ability to make sounds in May 1986, although she still has the ability to form words with her lips. Her hearing is failing but is still fairly good. She can understand speech, can read and watch television. Her most common form of active communication is by eye-blink response to questions. (One blink for "Yes," two blinks for "No.") With people who are trained to use them, she can also communicate by alphabet board and by computer. She cannot move her entire head, but she can move her facial muscles.

Mrs. Requena cannot now eat normally. However, she still has some limited ability to suck in nutrient fluids through a straw. That ability will soon be entirely gone. She has already suffered significant nutritional deficits. During the last two weeks she has lost 18 pounds. If artificial feeding through a nasogastric tube or other device is not quickly commenced, Mrs. Requena will probably die within a few weeks or a month. If artificial feeding is undertaken and maintained, Mrs. Requena may live for several years.

Although a person's ability to move is destroyed by ALS, the ability to experience sensation continues throughout the body. The disease itself does not cause pain, but the patient can experience pain from such things as body positioning and contact pressure. Mrs. Requena seems to have significant persistent pain. She is a very bright and aware person whose body has been steadily wasting away during the last 17 months. Her body is now almost totally useless. She is trapped within it. Most understandably, she feels enormous frustration and experiences a pervasive sense of helplessness and hopelessness. Her situation is desperately sad.

Mrs. Requena has always used her natural ability to swallow to its fullest extent. However, she has decided that when her natural ability to swallow has gone, she does not wish to be fed artificially. This decision does not involve any positive act to terminate life. It amounts to acquiescence in the natural shutting down of a critical bodily function. It involves a

conscious choice to accept death sooner rather than later. It does not amount either morally or legally to suicide. Many people in Mrs. Requena's position choose to be fed artificially and to prolong their lives. However, given the terribly dire circumstances confronting her, Beverly Requena's decision is readily understandable. I fail to see how an onlooker possessing an acceptable level of human compassion and sensibility could fault her for it. It is absolutely clear that Mrs. Requena has the legal right to make this decision. Matter of Conroy, 98 N.J. 321 (1985); In re Quinlan, 70 N.J. 10 (1976), cert. den. 429 U.S. 922, 97 S. Ct. 319, 50 L. Ed. 2d 289 (1976); Matter of Visbeck, 210 N.J. Super. 527 (Ch.Div.1986); In re Farrell, 212 N.J. Super. 294 (Ch.Div.1986).

Mrs. Requena's decision not to accept artificial feeding is something that she has been thinking about for more than one year. It is not the product of temporary depression. It has been fully articulated and firmly communicated to all interested parties for the past three months. All of the evidence in this case and my own questioning of Mrs. Requena in her hospital room convince me that she fully understands all of the implications of her decision, including the fact that her death by starvation and dehydration may be painful and unpleasant, and that she is voluntarily and knowingly making the decision.

Beverly Requena's decision not to receive artificial feeding is accepted by her treating physicians. It has been supported by her family, which consists of her husband, three adult children and a number of grandchildren. When the decision was first communicated to the Hospital's management on July 15, 1986, the Hospital immediately responded that the decision conflicted with its "pro-life" values which included a refusal on the part of the Hospital and its personnel to participate in the withholding of artificial feeding. As the parties have focused more sharply on the issues involved, various internal institutional bodies and officers of the Hospital have considered and reasserted its position on this matter. On September 11, 1986, the board of

trustees of the Hospital unanimously adopted the ...


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