A System on Trial?

In Akron, OH, continues the remarkable and disturbing murder prosecution of Mr. John Wise.  Last year, Mr. Wise walked into his wife’s hospital room and killed her with a shotgun.  The District Attorney has accused him of aggravated murder, murder and felonious assault, while his defense has labeled the act a “mercy killing.”  For many, these events put the legal system itself on trial, as it tries to decide whether intense emotional duress can be the basis for an insanity plea. For patients and families overwhelmed by the burden of terminal disease, perhaps what should actually be judged is not the courts, but the medical system.

Barbara and John Wise were married for 45 years, and by available accounts had a close and supportive relationship.  John suffers from diabetes, has a history of bladder cancer in remission, and is plagued by a peripheral neuropathy that makes his hands and feet numb.  Barbara, 65, was relatively healthy until she suffered a massive stroke that left her immobile and unable to speak.  According to Wise’s attorney, and also a former co-worker, the couple had agreed they never wished to be disabled or in a nursing home.

On July 28, 2012, one week after the stroke, John shot his wife, one time, and she died 24 hours later. Reportedly, he did not threaten hospital staff and was immediately disarmed and restrained by security.  After arraignment, he was released to his home with an ankle monitor.  Motions are presently being heard and his trial, if it occurs, will not be until at least spring.  Given the history of similar events, likely a plea bargain will be reached.

As our population ages and more elderly patients and couples experience acute and chronic disease, experts believe similar events are likely to occur with rising frequency.  The stress that results in such horrible desperation is overwhelmingly destructive and represents a failure of doctors and healthcare workers to give support, guidance and present alternatives.  Taking these events at face value, one can only begin to comprehend the depth of pain that John must have felt when he entered Barbara’s room.  If we are going to address such critical needs in medicine, being ready to intervene at these common, if extreme times, must be a core mission

There are several parts of “the system” which can help.  First, physicians must recognize the pain induced by acute and chronic health stress, and reach out, respond, discussing choices, such as social work, acute grief counseling and referral to palliative care.  Other contacts in the health system, be they emergency room staff, nurses, extended care facilities or pharmacists, must recognize their role to educate, and support.  At times “ancillary” professions, which we may not always view as gateways to healthcare, such as funeral home directors or estate attorneys, may be vital links.

Improving access to end-of-life services through hospice, can provide compassionate choice, ease stress and help shoulder emotional burdens.  Families should be educated that supports are available not only in the hospital, but in their homes, senior centers and extended care facilities. Some will propose this is a role for assisted suicide, but given the overwhelming and erratic emotions that are in play in these situations, our primary intervention should be to supply support and stability, and not potentiate extreme decisions with the potential for disruptive long-term guilt.

A civilized nation should be judged by how it treats and helps those in greatest need.  Clearly, those persons suddenly cast into hell by disease, those with limited supports, those with limited apparent alternatives, demonstrate great need.Given the likelihood that such highly traumatic medical events will increase, there is a role for all of us to open up our minds, eyes and hearts.


  • Maggie
    A civilized nation should find some way to be prepared for people to decide that catastrophic illness is unacceptable. Some people in their 60s would be happy to live in a nursing home for years or decades. Some people in identical circumstances would not. I suspect we don't know what Barbara may have communicated to John in the days after her stroke, using 'look up for yes' and the many ways of communication that develop in long marriages. Except for a brief sentence or two from the attorney and the co-worker, we probably don't have a lot of information about the conversations they had before this happened, about end-of-life scenarios, about massive disability, about being stuck in an unresponsive body. Approaching 70, I'm not immune to wondering about situations like this. But working in a hospital I'm all too aware of the medical assumption that everything that happens to a body can be treated, and if treatment is really determined to be futile (often after lots of actually-futile treatment has been tried) that's no problem, we'll just send you to a nursing home. But the reality is that the patient's quality of life has been abruptly altered, and the doctors are not doing much to address how the patient feels about that. When the healthy caregiver suddenly becomes the patient, in much worse shape than the spouse who has already needed help, the situation can become overwhelming for both. The best way to prevent shootings like this, and the turmoil they create for everyone, is to have a better plan than is currently available. And it's a national conversation that is long overdue.
    • James Salwitz, MD
      Thank you so much for the insight and expansion. You are so right ... if we just talked a little about these types of events before they happened, massive suffering could be averted. jcs
  • amy challener
    what do they mean by support, Having someone give you a few kinds word grief council. what does that do to allieviate the pain for the person suffering or the caregiver. who has the right to judge. If a person does not want to live in an unlivable condition, trapped in the body, should they have to? would you do that to your pet?
    • James Salwitz, MD
      If I had been asked by Mr Wise what to do for his wife, given both their desires not to "live" with major brain damage, I would have suggested inpatient hospice. After a large stroke if all that was done was to give her medicines for comfort (morphine and sedation if needed) her expected survival would be at most a couple weeks, perhaps just days. If Mr Wise had known he could sit by her side, say goodbye, and for her to be comfortable, in my experience he would have accepted that choice. As per your question, I would treat a pet of mine with comfort and dignity and would not shoot them so that they suffered through emergency surgery only to die 24 hours later, leaving a legacy of two ruined lives and jail time. I hope that if this kind of thing ever happens to me and my wife, someone will be there to help us get through. jcs

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