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WITHHOLDING HEALTH CARE IN FUTILE CASE UPHELD

A Massachusetts court ruled Friday that a hospital and its doctors need not provide care they deem futile, even if a patient has asked for it.

The case, which went to trial in the Superior Court of Massachusetts on April 4, involved an elderly woman, Catherine F. Gil-gunn, who became comatose and suffered irreversible neurological damage while a patient at Massachusetts General Hospital.Gilgunn's daughter, Joan Gilgunn, of the Charlestown section of Boston, said her mother had always wanted everything medically possible to be done for her if she became incompetent.

Catherine Gilgunn died Aug. 10, 1989, after her doctors at the hospital issued a "do-not-resuscitate order" over Joan Gilgunn's objections. Joan Gilgunn sued, saying the doctors were obligated to abide by her mother's wishes that she be kept alive as long as possible.

The lawsuit was apparently the first to test whether doctors must provide treatment that patients have requested, even when the doctors believe the care would be futile.

Friday, after two hours of deliberation, the jury found the hospital and two of its doctors, Dr. Edwin H. Cassem and Dr. William Dec, not guilty of neglect or of imposing emotional distress on Joan Gil-gunn.

Judge David Roseman had asked the jury to consider whether Catherine Gilgunn would have chosen to be resuscitated with cardiopulmonary resuscitation, or CPR, or to be kept on a ventilator if she had been able to express herself. The jury said that, yes, she would. Roseman also asked if the jury found such care futile. Again, the jury answered yes.

Joan Gilgunn's lawyers, led by Donald E. McNamee of Boston, said the case was about how society treated its most vulnerable members, people like Catherine Gilgunn, who could not speak for themselves.

Frank E. Reardon, a lawyer for the hospital, countered that the case was about the limits to patients' rights and whether doctors and hospitals should be required to provide care that they believe is futile and only prolongs the process of dying.

"I guess the real point," Reardon said in a telephone interview Friday, "is that in very rare instances, particularly in situations at the end of life, where medicine simply cannot hold off death, that physicians can't be required to do things that they feel would be inappropriate and harmful to the patient."

Dr. Sherwood Gorbach, chairman of the ethics committee at New England Medical Center in Boston, said the ruling was "enormously important." He said that virtually every week doctors at his hospital were confronted with families who demanded care that doctors thought was futile.

Until now, he said, doctors have tended to provide the care anyway, fearing that they were legally required to do so.