The right to die, the power to kill - controversy over euthanasia policy - includes related article on living wills and court decisions

IT WAS June 21, 1993. For thirty-year-old drifter Ronald Comeau, the day seemed to mark the end of the road. Under arrest in the small community of Bennington, Vermont, accused of robbing another homeless man, Ron was alone, seemingly with no one to turn to. It had been a long time since he had seen his father, and their relationship had never been good. His mother had no phone. He hadn't seen his brothers for nearly seven years. Even the police didn't care enough to watch him in the holding cell.

Minutes after being locked up, police say, he was found hanging from a noose he had made out of the trim of a cheap jail blanket.

The police cut him down. There was no pulse. He didn't appear to be breathing. Paramedics were called, CPR administered. Then, a weak pulse--maybe.

The paramedics arrived. More CPR. Then, a wailing ambulance ride to the Southwestern Vermont Medical Center. In the emergency room, Ron was given advanced life support. An injection of atropine. Two shots of electricity to restart the heart. It worked. After about 15 minutes without a pulse, Ron had a steady heartbeat.

Nothing unusual here. Go to any big-city hospital, or even small-town medical center, and you will find the unwanted, suffering through their last hours, who are helped as much as possible and then soon forgotten. But few would forget Ronald Comeau. Not the staff of the Southwestern Vermont Medical Center; and certainly not people such as clergyman Mike McHugh, retired teacher Joseph Schaaf, psychiatrist Peter Zorach, attorney Stephen Saltonstall, and Bennington Probate Court Judge Doris Buchanan. None of them knew it yet, but Ronald Comeau was about to become the center of a legal and emotional maelstrom.

Hopeless?

THE HOSPITAL located Ron's father, Renald Dupois of Maine, within hours. Amy Swisher, director of community relations for Southwestern vermont Metrical Center, says hospital personnel followed standard procedures in cases such as Ron's: they advised Mr. Dupois that his son was severely injured and might die, requested permission for HIV testing, and asked about the possibility of organ donation. There is some dispute as to the accuracy of this account. However, it is not disputed that Mr. Dupois did not come to his son's bedside and that, soon afterward, his phone was disconnected.

It was decided that Ron needed a guardian to make decisions on his behalf. Enter Joseph Schaaf, well known in the local legal community because of his volunteer work as a guardian ad litera (a temporary representative during a court case) in child-custody matters. He agreed to serve as Ron's permanent guardian without pay and was so appointed by Judge Buchanan on July 23.

By all accounts, Mr. Schaaf took his responsibilities very seriously, visiting Ron at least five days a week and discussing Ron's case with doctors and staff. By mid August, he had come to a difficult decision. Ron had been diagnosed as being in an irreversible persistent vegetative state. He was now awake, he had reflexes, but there appeared to be no cognitive ability whatsoever. Mr. Schaaf instructed Stephen Saltonstall, who was his pro-bono attorney in the Comeau matter, to seek permission from the Probate Court to remove the ventilator that aided Ron's breathing. This was expected to lead to the young man's death.

On August 17, a hearing was held before Judge Buohanan. Based on the testimony of the attending physician, Michael Algus, and a consulting neurologist, Keith Edwards, Judge Buchanan ruled that Ron was "unaware" of what was happening "around him and to him," and that there was "no reasonable possibility of recovery or improvement." Convinced it was in Ron's best interests, she signed the order permitting the ventilator to be withdrawn.

But Ron didn't die. Not only that, he began to improve. By the middle of September, he had emerged from his persistent vegetative state. He was now aware. But that was not a cause for joy. Joe Schaaf was horrified by Ron's condition. "I saw a person who could register some feelings, but those feelings were pain, agony, and fear. His hands were bent in toward his wrists. It appeared he was trying to remove his feeding tube. Whether it was a conscious act, I couldn't tell."

On occasion, others saw a different Ronald Comeau. Speech pathologist Juanita J. Cook noted in Ron's medical records, "Seems to recognize personnel--favorite nurses. On 9/21, definitely responded with recognition today when I went in and said my name, reminding him that I was the person who came in to talk--not to do any direct care, etc.--Big smile, with overall body movement. Very different from the grimace at having hands restrained." Other notes in the file show a man who was aware, sometimes grimacing, often seemingly in pain, at other times intently concentrating on discussions about his future care.

Out of His Misery

BUT RON REMAINED profoundly disabled. Joe Schaaf recalls, "I thought that if it were me there, lying helpless in a bed, I hope to God that someone would help me move on from my misery to whatever comes next, because whatever comes next can't be worse than that." He decided to raise the question of withholding food and fluids from Ron.