2. SAMMY LINARES
Sammy Linares was a normal six-month-old baby. But, on August 2, 1988, at a birthday party, Sammy's five-year-old sister handed him a balloon. Sammy played with the balloon, and then he swallowed it. It blocked his airways so that he couldn't breathe, and Sammy then had a heart attack.
For 20 minutes, Sammy's heart did not beat. During that time, no oxygen went to his brain. In the nearby hospital's emergency room, Sammy was resuscitated, but he could not breathe on his own. He was attached to a respirator, which forced air into his lungs. The local hospital did not really have the right equipment for handling a small child in critical condition. They called around and found a pediatric intensive care unit (PICU) that had a place for Sammy. He was transferred to the PICU at Rush-Presbyterian-St. Luke's Medical Center in Chicago.
The doctors predicted that, if Sammy survived the ordeal, he would suffer from severe brain damage from oxygen deprivation. The doctors actually felt that he probably would not survive for 24 hours.
But Sammy hung on. By the fourth day, with no improvement in sight and a dismal future ahead, Sammy's father Rudolfo urged the hospital staff to disconnect the respirator.
Lawyers at the hospital were worried that the hospital would get hit with a lawsuit by the state if Sammy were disconnected from the respirator, so Sammy stayed attached.
Sammy was in a coma for months; eventually his condition was described as a "permanent vegetative state." The likelihood that he could wake up and be who he once was had vanished. The doctors and the family all agreed that there was no hope. Everyone agreed that medicine and technology could not improve Sammy's condition. Sammy's physician was quoted in a news article as saying that "there was no ethical difference of opinion." What was at issue was whether someone or the hospital would or could be accused of murder if Sammy were disconnected from the respirator.
Sammy was transferred out of the hospital to a nursing home.
Not surprisingly, Sammy's parents and siblings were heartsick. The sister who had given him the balloon was devastated that she had done something that was "making Sammy so sick."
About four months after the accident, Sammy's father decided to disconnect the respirator himself. He had had a lot to drink and walked into Sammy's room and started to unplug the respirator. But he was caught doing it and was restrained while the staff reconnected Sammy to the machine.
The situation remained dismal. About eight months after the accident, Sammy's dad came back to the hospital, again drunk, but this time with a gun. He held the staff at bay while he disconnected the respirator. Then he held Sammy in his arms until Sammy died. It took about half an hour.
- Series of NY Times articles describing the case, April, May, June 1989.
- Law, Medicine, and Health Care 1989, 17(4):295-297; 298-307.
Students should understand the following:
- Characteristics of a "persistent vegetative state"
- How respirators work and why they are used
- Stresses associated with caring for a severely disabled child
- How stress can cause parents and other caregivers to do things they would find unthinkable otherwise
- Difficulties in defining death
- Differences between "killing" and "letting die"
- The impact that caring for a chronically ill person can have on nurses and other medical personnel
- Simple childhood accidents can contribute to life-long devastating conditions
Suggested questions for discussion
- Do you think Sammy should have been taken off the respirator when it was clear that he had no future? Who should have made that decision?
- Do you think the availability of a respirator eased, exacerbated, or caused the problem?
- Did the state laws of Illinois help in this situation or did their murkiness with respect to liability make things worse?
- Additional information about the Linares family became public after Sammy's death. Earlier in the day of the accident, the police had been at the Linares' house to deal with a disturbance. In addition, Sammy's mom was under investigation for welfare fraud. Sammy's dad had both alcohol and drug abuse problems; he was not drunk just on the two occasions when he decided to "unplug" his son. Mr. Linares also had been arrested a number of times. Do these facts about the family alter your thoughts about the case, how it was handled, and what should have been done?
Topics for discussion/written assessment
- What arguments can be made to support a decision to remove Sammy from the life support systems? What arguments oppose such a decision?
- What was the impact of the availability of the respirator on Sammy?s condition? How did the respirator affect the ability of Sammy?s parents to make decisions?
- How could or should the physicians have explained Sammy?s condition so that his parents could make an informed decision about his treatment?
Question for further investigation
- Examine the history of the development of safety devices such as seat belts, air bags, bicycle helmets, etc. Illustrate how these devices evolved out of reported cases of severe childhood accidents that left children damaged, disabled, or dead.
Topics for teacher preparation
- Respirators (why a person is put on one, how it works, what happens when a person is taken off, etc.)
- Biology of respiration, heart attack, and other medical complications
- Family dynamics and how they can affect behavior
- The state intervention system
- Legal battles arising because state laws are ambiguous
- Nurses' reactions to the patient and the family
- The media's role in public understanding of and reactions to the case (they were sympathetic to the father but did talk about his drug problems)