Pulling the Plug: Ethicists Debate Ramirez Case

June 28, 2007 — -- Two short weeks after the culmination of a legal battle between his wife and family over whether to maintain his life support, Jesse Ramirez of Arizona appears to be on the road to recovery.

According to local reports, Ramirez, 36, suffered traumatic brain injury in a May 30 car accident, which put him in a coma. He had been in this minimally-conscious state for a little more than a week when doctors informed his wife that he may never recover -- and she made the decision to have his feeding and water tubes removed.

Ramirez's family made a legal appeal and won, and his feeding tubes were reconnected. Now, Ramirez has regained consciousness and recovered to the extent that he can interact with visitors.

It is an episode that some are already suggesting echoes the 2005 case of Terri Schiavo, a woman whose brain injury led to a persistent vegetative state. In her case, a protracted legal battle between her husband and Schiavo's family ended in the removal of her feeding tube and her subsequent death.

But ethicists debate the extent to which this comparison is valid.

"This guy was not hopeless and in a persistent vegetative state by any means," says Dr. Steven Miles, professor of internal medicine and bioethics at the University of Minnesota Center for Bioethics. "It has no impact on the bigger debate of life support."

If there is one point of accord among both ethicists and neurologists, it is that Ramirez's recovery falls far short of a medical miracle.

"This is by no means a miracle of any kind," Miles says. "Traumatic comas are notorious for late wake-ups."

Dr. Ausim Azizi, chairman of neurology at the Temple University School of Medicine, agrees.

"There is actually a physical basis for those who recover," he says. "The reason they call it a miracle is because they're so rare."

The doctors said much of the reason that Ramirez recovered from his minimally-conscious state -- while so many others with brain damage do not -- has to do with the nature of his injury.