Michigan verdict may affect parents' right to decide fate of preemies.

A Michigan jury recently handed down a verdict that may affect the rights of parents to decide whether prematurely born children should receive life-sustaining medical care.

Gregory Messenger, who was charged with involuntary manslaughter for removing his premature infant son from a respirator shortly after birth last year, was acquitted of the charges in early February after a two-week trial. (People v. Messenger, No. 9467694FH (Mich., Ingham County Cir. Ct. Feb. 2, 1995).)

Messenger, a 40-year-old dermatologist, admitted that he had taken his son off the respirator about an hour and a half after he was born. The baby was delivered 15 weeks premature and weighed less than 2 pounds.

A few hours before the birth, a neonatologist told Messenger and his wife that the baby would have a 30 percent to 50 percent chance of survival, and that if he survived he could suffer severely disabling medical complications. The Messengers told the hospital staff to take no extraordinary measures to save the baby.

But shortly after the birth, a physician's assistant placed the infant on a respirator in the neonatal intensive care unit. When Messenger discovered this, he asked that the machine be disconnected, but the physician's assistant refused.

At the Messenger's request, the hospital staff left them alone with the baby for a few minutes, and Messenger disconnected the respirator. The infant boy died a few minutes later in his mother's arms.

Although a medical examiner ruled the death a homicide, Messenger's attorney, Frank Reynolds, said his client did nothing wrong.

"There was no crime committed," Reynolds said from Lansing, Michigan, pointing out that in Michigan parents can withhold or withdraw life-sustaining medical treatment for a minor child if it is in the child's best interests.

The medically, and ethically ambiguous "best interests" issue became the focus of the case, which gained national attention. Messenger, who faced up to 15 years in prison if convicted, testified that he had a right to act in his son's best interests by disconnecting the respirator.

Prosecutors claimed that Messenger had acted too soon to make an informed decision about his son's medical care. The baby's neonatologist testified that she had wanted to do further medical tests before recommending a course of treatment.

But the Messengers believed that waiting for additional test results would have merely prolonged the baby's pain and suffering, according to Reynolds. He said the grim prognosis for the baby and his condition at birth - lifeless, abnormally small, and suffering oxygen deprivation - was enough information for Messenger to act in his child's best interests.

To help the jury sort through the difficult medical, ethical, and moral questions in the case, Reynolds called a Jesuit priest, John Parrish, to testify on Messenger's behalf. Parrish, an ethicist at Boston College, had served as a consultant to a presidential commission on life-saving medical treatment in the 1980s.

Parrish likened the Messengers' dilemma to that of a heart-attack patient who must undergo life-threatening travel to another city for treatment. If the patient is told he has a 50 percent to 70 percent chance of dying en route and that the treatment is likely to involve debilitating complications, the patient has no ethical or moral obligation to make the trip, Parrish said. Instead, the patient can simply request sufficient medical treatment to remain comfortable until death.

The same decision-making process applied in the Messengers' case, Parrish said. The only difference is that because the patient was a baby, the parents had to speak for him.

Although the verdict does not set a legal precedent for other similar cases, Reynolds thinks it will nevertheless affect the future rights of parents of premature infants.

"The case has had a major impact throughout the country. These issues are going to be addressed more and more because parents are starting to say we will be involved in the decision making," Reynolds said.

Some medical ethicists predict that hospitals will now review their policies regarding care of premature infants and that doctors may be more willing to follow parents' wishes. (See Valarie Basheda, Messenger Case Could Broaden Parents' Rights in Health Choices, Det. News, Feb. 3, 1995, at 1.)

Whether parental rights in these cases will be strengthened by the Messenger verdict remain to be seen. Reynolds noted that the law in this area is murky. State laws that govern the rights of parents to remove children from life support vary, and no appellate opinions deal directly with the medical care of premature infants, he said.