This transcript is from National Public Radio (NPR) "Morning Edition." January 21, 1994

Octogenarian May Be Forced to Undergo Shock Treatment

Bob Edwards, Host: A case before the Illinois Appeals Court will decide whether an elderly woman suffering from senile dementia can decline medical treatment. The case concerns Lucille Austwick, an 81-year-old woman who lives in an Illinois nursing home as a ward of the state. In addition to her dementia, she suffers from severe depression, and her doctors believe she needs electroconvulsive therapy. Austwick says she doesn't want the treatment. It's up to the court to decide whether she has the right to say no. Wendy Shmelzer reports.

Wendy Shmelzer, Reporter: To understand why Lucille Austwick at 81 finds herself in the middle of a battle with doctors and lawyers about a treatment she doesn't seem to want, you first have to know something about her health and the state of Illinois. Lucille Austwick suffers from senile dementia. People who know her say there are times in her day when she seems quite lucid and alert, but there are many other moments when she's confused and irrational.

Because of the dementia, she's been declared mentally incompetent by a judge. But now Mrs. Austwick is also severely depressed. That's not uncommon, say experts, for patients with dementia. Twenty to 40 percent suffer from depression. What may be more unusual though is the treatment her doctors prescribe for the depression - electroconvulsive therapy, or ECT.

Dr. Lawrence Lazarus, Geriatric Psychiatrist: No, it would not be - it would not be a common approach, and it usually is not the first approach.

Shmelzer: Dr. Lawrence Lazarus is a geriatric psychiatrist in Chicago who's familiar with the case. He says that electroconvulsive therapy, a procedure which delivers a short burst of electricity to the brain, under anesthesia, of course, is usually considered for severe depression when other treatments fail.

Dr. Lazarus: The first approach then would be antidepressant medication. If anti depressants didn't work, the patient was still severely depressed and there was a threat of loss of life from complications of depression, which are often malnutrition or dehydration, then in very certain - very particular situations, ECT could be another treatment that could be considered.

Shmelzer: That, say experts, is what happened here. Mrs. Austwick's physicians believed that she was in real danger. Anti depressants weren't working; ECT seemed like their best bet. Here was a medical condition, they reasoned, for which there was an effective and appropriate treatment. "Would you hesitate to treat that same patient," asked psychiatrist Lawrence Lazarus, "if she had pneumonia?"

Dr. Lazarus: If it's felt that the patient's quality of life was fairly reasonable at the nursing home and is found to be severely depressed, then the treatment team, including the physician, may decide that treatment for the depression would be a humane approach to this woman. But, at some point, there's usually some consensus of what should be done. And how that consensus is reached is a very, very complicated process.

Shmelzer: And it's intentionally complicated in the state of Illinois because ECT is an invasive and controversial procedure. To protect patients like Lucille Austwick, who have been deemed mentally incompetent, a legal guardian must first go to court to get permission for the treatment. that's precisely what Patrick Murphy, Mrs. Austwick's guardian for the last two years, did. Now, you should know that Mr. Murphy is personally opposed to ECT for patients like Mrs. Austwick, and when he tried to explain the procedure to Mrs. Austwick, she indicated that she didn't want the ECT. Still, Mr. Murphy felt uncomfortable vetoing a treatment that Mrs. Austwick's doctors so persuasively recommended.

Patrick Murphy, Guardian: In the past, I just have flatly refused to agree to ECT, figuring out it wasn't in the ward's best interest. In this case, I went to court and informed the court that the doctors - all of whom I respect greatly, by the way - wanted to do ECT, that I was opposed to it, but I felt the court should have the final word.

Shmelzer: And there was another reason to go to court - Murphy runs the Cook County Guardian's Office. From time to time he has other wards in similar positions. For Mrs. Austwick and these other cases, Murphy felt he needed guidance from the court.

Mr. Murphy: I think that what we see from very many people is that they basically have given up hope and want to die. And people do that in a variety of ways. You know, some people unconsciously maybe walk in front of trains. An elderly person quits eating, doesn't take care of herself. She's sending out a message that she wants to die.

Shmelzer: Late last year a hearing took place to determine whether electroconvulsive therapy would be in Mrs. Austwick's best interest.

Mr. Murphy: The court found that it was in her best interest to have it because he felt that it would improve her quality of life. And, in fact, in this case, by the way, the judge is also 80 years old coincidentally.

Shmelzer: But the story doesn't stop here. As soon as the guardian, Mr. Murphy, petitioned the court, the judge, as is the practice, appointed yet another attorney to represent Mrs. Austwick at the hearing. This attorney's job was to oppose electroconvulsive therapy and represent Mrs. Austwick's wishes. Laura Spahn, Mrs. Austwick's new advocate, argued at the hearing that ECT was not in her client's best interest.

But then Spahn went even further. She argued that the court should use a different standard, something called the Substituted Judgment Standard. She said the court should have tried to find out what Lucille Austwick would have done had she been competent. The court needed to hear evidence about Mrs. Austwick's prior life, her family, her beliefs. Spahn's argument is part of the appeal, which will be heard in the next few months. And this time, hopes Spahn, they'll consider the Substituted Judgment Standard and what Mrs. Austwick would want.

Laura Spahn, Attorney: She does have dementia, so it is hard to understand how much she comprehends of the situation and of the proposed treatments. But she's said again and again that she does not want the ECT. She said that if the doctors are so interested in doing these kinds of treatments, that they should do them to themselves. The only thing she has told me is that she does not want the treatments.

Shmelzer: And there's another factor to consider. Lucille Austwick has a younger sister. While Geraldine Champlin hasn't been involved with her sister for years, and bears no legal responsibility, Mrs. Champlin is quite certain that she knows what her sister would want.

Geraldine Champlin, Lucille's sister: She'd want to be left alone. She wanted to finish her last days like she's doing. If she were in pain, or something like that, I'd say help her. But if she's lying comfortably in bed, and maybe they have to go in and change her and try to feed her, if she doesn't want to eat, let her alone. I think she just wants to be left alone.

Shmelzer: While this case is about Lucille Austwick and whether she should have electroconvulsive therapy, it evokes strong feelings about larger issues as well. There is debate about the long-term effectiveness of ECT, and potential risks. But, the real controversy, say experts, in deciding how to treat Lucille Austwick, reflects the same difficulties and uncertainties we as a society face in deciding when to say enough is enough, and allow 81-year-old women, whether competent or incompetent, to decline recommended treatment. Legal experts and mental health professionals will be looking, they say, to these types of cases for guidance.