At death's door

On March 23, 2004, William and Kay McClanahan celebrated their 30th anniversary by reenacting their first date: They ate pizza and worked crossword puzzles. Last week, Mrs. McClanahan marked their 31st by attending a medical ethics board at which a team of doctors told her she may soon have to let her husband die.

On April 27, 2004, after a full day of training horses on his South Carolina farm, Mr. McClanahan, 74, took his wife out to dinner. But after the meal, his heart suddenly stopped beating. Mrs. McClanahan, 60, a retired forensic chemist and law enforcement agent, administered CPR until medics arrived and revived him. Mr. McClanahan remained unconscious, breathing on his own, but aided by a respirator. In June, Mrs. McClanahan had him transferred to the Medical University of South Carolina (MUSC), a highly reputed facility where she had once worked as a biochemical researcher.

"I thought he would be safe here," she told WORLD, speaking on the phone from her husband's bedside. But he isn't safe, she said. Mrs. McClanahan contends her husband might already have recovered if MUSC doctors hadn't aligned their care plan with their prognosis that he never would. Instead, he is near death.

Once at MUSC, Mrs. McClanahan said, doctors and nurses began asking her repeatedly whether Mr. McClanahan would want to live in his impaired condition. "I told them, yes!" she said. "He would want to be with me. We did not sign living wills because we did not want to give up. We wanted medical [professionals] to make every effort to improve our condition, then put the result in the hands of God."

Still, she said, medical staff told her she was "in denial" about her husband's true condition, and that he wasn't really "living." One doctor, Mrs. McClanahan said, told her she felt "an ethical duty not to treat" Mr. McClanahan because he would experience an "impaired quality of life." Against Mrs. McClanahan's wishes, she charges, doctors also put him on a "Do Not Resuscitate" list, though that's illegal in South Carolina, according to Jan Warner, a Columbia elder-law attorney.

The McClanahans may be victims of what is known as "futile care theory," a medical trend in which doctors and hospitals set policies that allow medical staff to withdraw or deny treatment over a family's objections. Two states, Texas and California, have statutes that allow such policies, but futile care protocols have also turned up in Des Moines, Iowa. MUSC's legal affairs department did not return calls seeking information on whether MUSC has a futile care policy.

Beginning in May, Mrs. McClanahan began seeing what she calls "small miracles." Mr. McClanahan regained movement, began opening and focusing his eyes, and blinking "yes" answers. But Mrs. McClanahan said MUSC personnel dismissed signs of neurological improvement, and some said he couldn't feel pain even when he appeared to be writhing in it.

By Christmas, Mr. McClanahan could breathe for 11 hours without a ventilator. But about two weeks later, his wife said, the doctor in charge of his care declared that Mr. McClanahan had only about three months to live. Meanwhile, a pre-existing heart problem flared up, but she said the doctor told her that the MUSC administrator refused to transfer her husband back to the main acute care facility. Instead, she said, the doctor radically changed his medications, a move she believes reversed all progress and sent her husband into sharp decline. Following that, doctors removed Mr. McClanahan's heart monitor.

MUSC medical director John Heffner did not return three calls for comment. Meanwhile, Mrs. McClanahan said she contacted at least four doctors outside MUSC who were willing to have Mr. McClanahan transferred into their care. But she said each changed his mind after speaking with MUSC personnel. In mid-March, Mrs. McClanahan hired an attorney to help her fight for her husband, who she believes can't last much longer.

"I desperately need a doctor who will get my husband into another hospital in time to save his life," Mrs. McClanahan said. "I need someone who believes in Bill's right to life."