Monday, September 1, 2003

CHARLOTTESVILLE, Va. — Jerry Childress swears his 26-year-old son’s pulse and blood pressure jump on hospital monitors from the sound of a familiar voice or the roar of a NASCAR race on television.

To his father, Jason Childress is a fighter, a stubborn man who needs time to heal from massive brain damage that left him in a vegetative state.

Mr. Childress’ mother, sister and fiancee disagree, putting the two sides at legal odds.

“There’s nothing I would want more than for him to open his eyes,” Amy Little said of her brother. “But he used to work in a nursing home, and he said he wouldn’t want to live that way.”

In what appears to be a unique situation, the decision on Mr. Childress’ future will be made by a court-appointed guardian because his divorced parents cannot agree on whether he should continue to live on life support. No deadline has been set for a decision.

Experts say they don’t know of a case in which the disagreement between parents ran so deep that the ultimate decision came to rest with a court-appointed guardian chosen for his neutrality.

Lawrence Nelson, a philosophy professor at Santa Clara University in Santa Clara, Calif., and a lawyer who has worked on several life-support cases, said most don’t involve patients so young and, when they do, usually parents can reach an understanding on the best course of care.

“Having a stranger do it instead of a concerned family member is pretty odd,” Mr. Nelson said.

Jerry Childress, who slips in and out of referring to his son in the past tense, vows to appeal any decision that would allow Jason to die.

“I’ve come to the realization that he’s going to have some disabilities, but I believe that if Jason did not want to be here, he would not have made it this far,” he said. “He loves a challenge.”

Making the life-or-death decision is Herbert A. Pickford III, a retired Circuit Court judge from Charlottesville who is known locally for his thoroughness and fairness.

“I’m talking to the doctors, seeing the patient, talking to the parents and siblings and trying to determine if he’s ever expressed any wishes that would have bearing on the situation,” Judge Pickford said in an interview. “Both sides are so far apart.”

Mr. Childress, a father of three young children, lost control of his 1986 Ford Mustang on July 15 after a long day of fishing in rural Campbell County. The crash ejected him and destroyed several portions of his brain, leaving him unable to communicate, voluntarily move or respond.

He is unmarried, has no adult children and left no written instructions, so responsibility for his care rests with his parents under Virginia law. That shifted to the courts when they could not agree about whether to allow doctors at the University of Virginia Medical Center to perform a life-prolonging procedure allowing him to breathe without a ventilator.

Dr. Ross Bullock, a neurosurgeon and chief of the head trauma program at Virginia Commonwealth University Medical Center in Richmond, said it’s possible Mr. Childress’ vital signs do jump at the sound of voices. It’s also common for vegetative patients to appear to be looking around and for limbs to move, but Dr. Bullock said the signs should not be mistaken for conscious responses.

“Less than a quarter of a percent of patients that are truly in vegetative states, which means he’s like this after three months, recover to the point of being able to do things for themselves,” said Dr. Bullock, who is not involved in Mr. Childress’ care.

Mr. Childress’ doctors declined to discuss the case. But court records indicate a decision must be made about whether to perform a tracheotomy, which would create an air hole in his windpipe and allow him to live “probably in a vegetative state” without a ventilator, or simply to remove the ventilator. Judge Pickford said if the ventilator was removed and the tracheotomy not performed, Mr. Childress likely would die in a couple of days.

A decision also must be made about whether to resuscitate him if he stops breathing.

Meanwhile, the families take turns visiting.

Under an agreement, those intent on keeping Mr. Childress alive — his father, stepmother and brother — make the hour drive to Charlottesville from Lynchburg in the mornings, and those ready to let go may come in the evenings.

Katrina Childress, his stepmother, reads him fishing magazines, plays country music for him and prays with him. Jerry Childress narrates NASCAR races and talks to him about the family garage and body shop that he said Jason had hoped would become his own.

They say he is a patient man who has delighted in fishing “since he could walk.” He had recently discovered the thrill of playing chess on the Internet. He loved being a father and knew how to make each of his children — and his 6-year-old stepbrother — feel special, his stepmother said.

For other family members, the question hinges on the quality of the life he faces.

Mrs. Little, his sister, said Mr. Childress was deeply disturbed when his 9-year-old niece was temporarily paralyzed from the neck down. “He couldn’t understand how people could live like that,” she said.

Mr. Childress’ mother, Theresa Spencer, and his fiancee, Elizabeth Hamlett, could not be reached for comment. Miss Spencer’s attorney, Joseph A. Sanzone, wrote in court papers that doctors have told his client that there is “no reasonable or foreseeable prospect of recovery,” and that Mr. Childress would not want to continue living if he “could not regain consciousness and return to a meaningful life.”

He added in a telephone interview: “The modern reality is that we could probably keep someone breathing and their kidneys functioning for a hundred years, but what does that mean for the quality of life?”

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