Litigation as Spiritual Practice by George J. Felos

Litigation as Spiritual Practice George J. Felos Order now, with secure on-line order form ISBN: 1-57733-104-4, 344 pp., 6x9, hardcover, $24.95 Quantity

With this meeting, Attorney George Felos became the legal advocate of Estelle Browning's right-to-die and in the process plumbed the depths of death and dying and spearheaded a social revolution to enable death with dignity in the state of Florida. Felos uses this case and Fellouzis vs. United States of America - a decade-long tax battle sending him to Hong Kong's back alleys in search of antique jades and ivories - as framework to interweave the story of his law practice and spiritual unfoldment.

Litigation as Spiritual Practice describes the excitement and drama of the courtroom, and the ecstasy and anguish of spiritual evolution in a combative environment.

If the seemingly barren and war-strewn field of litigation can be the playground where spirit dances, it can revel anywhere.

"Here is a masterful blend of spiritual awareness and legal expertise. I am deeply impressed by George J. Felos' dedication to serving and bringing healing and well-being through the legal profession. I wish every lawyer would read this inspiring book, as well as those seeking to empower themselves in their personal lives. This is a breakthrough!" Alan Cohen, author of Wisdom of the Heart

"This book could be called 'God in the Courtroom.' It is a wonderful and amazing step on the path that our legal system must take if it is to truly heal and resolve the differences that arise between us. This book is a miracle. I am going to call George Felos God's Lawyer from now on." Neale Donald Walsch, author of Conversations with God

"Yoga philosophy draws heavily on the analogy of life as a battlefield between the ego and who we are beyond the ego. Telling the story of his real-life battles in the courtroom and reflecting on his inner journey into the practice of the perennial philosophies of yoga and meditation, George Felos offers a fascinating doorway into the inner and outer struggle of the Self." Sudhir Jonathan Foust, President, Kripalu Center for Yoga and Health

"At the heart of every conflict, no matter how severe, is a place of peace and stillness which, when accessed, provides true power and genuine healing. In this clearly written and heartfelt book, George J. Felos shows that when this stillness is intentionally accessed in the harsh practice of litigation, miracles happen. Books about spirituality are countless, but this one - fusing the spiritual with the rationality of a skilled attorney's mind - is extraordinary." Colin C. Tipping, author of Radical Forgiveness

"Simply a unique, brilliant accomplishment. Felos has woven into a most gripping, fascinating personal account, that had me as spellbound as the best novel, a splendid summary of the best of contemporary spiritual understanding and practice, while giving a fascinating insight into contemporary legal practice. I can't recommend it highly enough." Joseph Chilton Pearce, Author of Crack in the Cosmic Egg and Magical Child

Such a deep, dark, silent blue. I stared as far into her eyes as I could, hoping to sense some glimmer of understanding, some hint of awareness. The deeper I dove, the darker became the blue, until the blue became the black of some bottomless lake. "Mrs. Browning, do you want to die? ... Do you want to die?"-I near shouted as I continued to peer into her pools of strikingly beautiful but incognizant blue. It felt so eerie. Her eyes were wide open and crystal clear, but instead of the warmth of lucidity, they burned with the ice of expressionlessness. Before me lay Estelle M. Browning, fetally curled on her side in a nursing home bed. Her head was propped by a pillow upon which her still ample white-gray hair scattered. She was incontinent of bladder and bowel as evidenced by the numerous tubes exiting from under the sheet unto other places discreetly hidden. A victim of a major stroke in 1986, she had been in this condition, more or less, for the past year and a half. Her limbs looked frozen and in fact had become forever locked from the paralysis secondary to the stroke.

Mrs. Browning was a total-care patient, and as her body atrophied from lack of use, the intervention to keep her functioning necessarily increased. Bedsores, despite efforts to prevent them, were a constant problem. Discharges and infections involving almost every body orifice were routine. Even the simplest tasks like trimming her toenails required a podiatrist's debridement of necrotic tissue. And all this was made possible by a simple device that stood before me: Mrs. Browning's nasogastric feeding tube.

A plastic sack half filled with sickly beige-looking fluid hung from a metal I.V. pole attached to her bed. From the bottom of the sack a plastic tube snaked down into Mrs. Browning's nose, up through her nasal passage, down through her throat and into her stomach. However uncomfortable you might imagine this to be, the reality is much worse. Mentally competent patients fed through nasogastric tubes on a temporary basis uniformly describe the discomfort as unbearable. Incompetent patients often end up with their wrists tied to the sides of their beds due to their repeated removal of the tube.

There was nothing mechanical about the device at her bedside-just the pull of gravity causing a constant drip, drip, drip from the bag into the tube, regulated by a simple knob which adjusted the size of the aperture at the bottom of the sack. While "assisted feeding" might evoke images of Mom and apple pie, the contents of the sack bore little resemblance to food. This wasn't a homogenized ham sandwich Mrs. Browning was having for lunch, but an amalgam of chemicals in a fluid delivery system registered as a drug with the F.D.A. And as with many drugs, this one causes unwelcome side effects, most notably a whole range of digestive and excretory problems. At the other end, frequent vomiting clogs the tube and requires its removal, cleaning and reinsertion. I surmised that Mrs. Browning's tube was performing its function, as its recipient was more amply fleshed than I had quite expected.

Whatever your opinion about tube feeding, the hard fact was, it now stood between Mrs. Browning and her death. As is common with a major stroke, Mrs. Browning had lost the ability to swallow. The swallowing reflex is physiologically complex, requiring numerous muscular acts to occur in precise coordination. Damage from a stroke interrupts messages from the brain to the body, and thus many stroke victims have to "relearn" how to swallow in the same way that speech and movement are retaught. Depending upon your opinion, those may be the lucky ones. For Mrs. Browning, the stroke was so massive that attempts at rehabilitative therapies proved fruitless and were terminated after a few months.

Medical prognosis at the onset of an acute cerebrovascular accident, (a CVA), is highly problematic. The extent of the patient's damage and the likelihood, if any, of recovery are extremely difficult to determine during the initial weeks after an acute CVA. After major strokes, some people make astounding and near complete recoveries; others don't improve at all, and many decline rapidly and die.

Due to this variability and the uncertainty of predicting which outcome may occur, artificial provision of nutrition and hydration is routinely instituted post-CVA. And for some it definitely is a lifesaver. Many patients would not have the opportunity to recover and lead successful and happy lives were it not for nasogastric and gastric feeding. A gastric feeding tube is surgically inserted directly into the stomach, thus bypassing the nose and throat. Otherwise the delivery system is the same. Medicine prefers gastric tubes for longer-term use, as degrading nasal tissue becomes a problem after a few months of nasogastric feeding.

For Mrs. Browning, as well as for countless Floridians like her, the feeding tube was not a chance for hope, but, as seen from the eyes of most others, an instrument to cruelly perpetuate, a painful, degrading, and horrific existence. While medically appropriate when first inserted, Mrs. Browning's feeding tube became, once her prognosis was known, an unwelcome agent artificially prolonging the natural process of her death.

Distaste for Mrs. Browning's forced feeding was more than a matter of general consensus. A year or two before her stroke, Mrs. Browning had signed a "living will." In it, she specifically refused artificial provision of nutrition, should she develop a condition she could not recover from which made her death imminent. Her living will was unusual because most documents of that time did not address the issue of artificial feeding.

The "right-to-die" issue had burst into the public consciousness through the Karen Ann Quinlan case, which involved the use of a respirator. The 1970s proved to be the legal battleground regarding use of that device upon the terminally ill, and by the early 1980s most jurists and ethicists concurred that the mere existence of medical technology did not necessarily mandate its use. Feeding tubes were different. When patients and their families started to assert the same rationale and legal precedent in the mid-1980s in attempts to refuse or terminate artificial feeding, they were met with stiff legal opposition and moral outrage. By the time Mrs. Browning had suffered her stroke, the procedure for removing a respirator had become commonplace; but terminating artificial feeding remained a monumental task. Once inserted, the feeding tube assumed a life of its own, and as we later would grimly joke, the tube appeared to have more rights than the patient.

Courts throughout the country were all over the place on this issue and decidedly reluctant, if not unhappy, to be the societal arbiters of this conflict. Deciding whether artificial provision of nutrition could be terminated, and if so under what circumstances and procedure, involved the weighing of complex moral, ethical, medical, and legal concerns. Making this decision was much better suited to the deliberative process of a legislative body. There, fact-finding and discussion, which can include all interested parties, could hopefully result in a consensus for applicable legislation.

The courts acknowledged that the adversary system at the heart of our jurisprudence, with its strict adherence to rules of evidence, was a poor way to formulate public policy regarding right-to-die. Unfortunately for the courts, "pulling the plug" on the terminally ill, especially when that "plug" provided nutrition, was a political hot potato most legislators were delighted to toss back to the judges. As a result, policy was being set piecemeal on a case by case basis. Next time you complain about courts legislating, vent your frustration on your elected representatives!

The methodology for deciding pre-feeding tube cases was varied. Some courts permitted withdrawal of life support when the medical procedure was deemed to be "heroic" as opposed to "routine." Other courts ruled that "invasive" rather than "non- invasive" procedures were permissibly terminated. Of course these judicially provided labels did little to guide other patients, their families, or health care providers. What might be considered heroic or invasive in one situation might prove to be non-invasive in another case, depending upon the prognosis of the particular patient and other subjective conditions. Other courts were not as concerned with the type of medical treatment in question, but focused more on determining the treatment preferences of the patient. Since most treatment decisions in these situations involve those who are mentally incapacitated or physically unable to communicate, determining patient intent is problematic.

The courts had great difficulty applying these rationales to feeding tube cases. Termination of sustenance evoked strong emotional responses, and judges were reluctant to sign their names to an order that many observers claimed was tantamount to a death sentence by starvation. Actually, death was usually caused by dehydration-induced electrolyte imbalance in seven to ten days. Unlike certain medical technology that could stave off death for only a short period of time, a feeding tube could keep a vegetative patient alive for years-in one noted case, a ghastly eighteen years. Some courts even adopted the argument that artificial provision of sustenance did not constitute medical treatment at all, and therefore could not be terminated under any circumstances.

For Mrs. Browning it was Florida law that mattered. This issue had twice reached the Florida appellate system. Appellate courts review the work of trial courts and the pronouncements of the former become the reported decisional law under which trial judges are bound. In the first case, the Supreme Court of Florida permitted the withdrawal of a feeding tube from a competent patient agonized by the final stages of amyotrophic lateral sclerosis-Lou Gehrig's disease. There, artificial feeding would only prolong life a few more months, and the patient clearly and consistently expressed his desire to terminate a life he described as unbearable suffering. The court concluded that the state had no right to interfere in what appeared to be a reasonable choice unquestionably made by a patient facing imminent death.

While a bit helpful, this case didn't apply to Mrs. Browning. She was neither competent to express a choice nor was her death, with artificial feeding in place, imminent. The status of the patient's competence was important to the Florida court. Its comfort zone in terminating artificial provision of nutrition was much greater when the patient could speak for himself or herself.

State authorities gave little or no comfort to the families of incompetent patients. Prosecutors argued that a surrogate could not choose death for the patient, even if the person had expressed such a desire while previously capable. They reasoned there was always a chance the once competent but now uncommunicative person had later changed her mind. How could one possibly prove this negative-that the patient hadn't changed her mind? Of course the State's logic nullifies all previous expressions of the person's intent, invalidates any living will the patient had executed, and takes from her the right to plan for such situations while she has an ability to do so. The result? Tube feeding is mandatory for all incompetent patients lacking the natural ability to eat.

The other Florida appellate decision was factually closer to Mrs. Browning's situation. There, a lower appellate court ruled that a feeding tube could be removed from a patient in an irreversible coma or permanent vegetative state. The court did not mention or discuss the issue of patient intent, but seemed to focus solely on the medical condition. In either a coma or vegetative state, the patient totally lacks the capacity for reasoning and other higher brain function, leaving only automatic brain stem activity extant. For judges in these cases, quality of life apparently was the determining factor. When illness or accident permanently reduces the person to nothing more than mindless flesh, this opinion suggested that artificial feeding, as well as any other treatment, may be terminated without inquiry into the subjective wishes of the patient.

Mrs. Browning clearly was not in a coma. And while a vegetative state is less precisely defined and more difficult to diagnose, Mrs. Browning was more than vegetative, as she appeared able at times to interact with her environment in a rudimentary way. The medical records and nursing home aides reported that she occasionally would smile when an employee's child visited. Although Mrs. Browning could not speak, the aides insisted she made infrequent utterances "in an attempt to communicate." The health care providers also claimed they could detect differing moods, and there seemed to be no question Mrs. Browning could experience pain. She often emitted low moans and grunts when handled.

This portrait of Mrs. Browning's consciousness directly contradicted the observation and experience of Mrs. Herbert, who was also her live-in companion and sole surviving relative. Doris Herbert, in her early eighties, visited her elder cousin at least twice per week at the nursing home. She had initially visited on a daily basis until it became clear to her Mrs. Browning was non-responsive and would remain as such. Mrs. Herbert scoffed at the reports and suggestions of her cousin's rudimentary mental abilities and sorrowfully proclaimed that Mrs. Browning had become nothing more than a cash cow for the nursing home.

Undoubtedly, feeding tubes had become big business. Regulations issued by the Florida Department of Health and Rehabilitative Services made it virtually impossible to remove feeding tubes from nursing home patients without obtaining a court order. If the patient were incompetent, as most were, the judge would insist on proof of a permanent coma or vegetative condition. And of those patients, few of their families, even if emotionally capable and financially able, chose to expend the time, money, and effort to hire a lawyer and go to court.

Why not bypass the nursing home and the court, bring your loved one home, and pull the tube yourself? How does prosecution for murder sound? With no appellate court or statute declaring artificial feeding terminable without court order, or terminable under any circumstance for a non-vegetative incompetent patient, your local prosecutor was just a phone call away from an officious nursing home administrator. Additionally, not many families were emotionally or physically equipped to administer this end-of-life care without assistance. As a result, Mrs. Browning was just one of the estimated hundreds or thousands of incompetent Florida nursing home patients kept barely alive through tube feeding. At approximately $2,000 per month per patient for the privilege of basic nursing home residence, feeding tubes indeed were a financial windfall in Florida to the probable tune of tens of millions of dollars per year.

Mrs. Herbert had reason to be suspicious of the nursing home's motives and its sanguine assessment of her cousin. Not only did feeding tubes perpetuate a clientele, they greatly reduced the cost of labor. Assisting an impaired nursing home resident to naturally intake food is very time intensive. Not only may a resident need help to get the spoon to his or her mouth, but the food must be cut or mashed and the resident may often require repeated encouragement to eat. How better to free up an aide's time, and the employer's money, than by commencing tube feeding? All the aide need do is change a bag once or twice a day, expending a few minutes rather than an hour or more in direct resident care.

Countless incompetent patients have been prematurely intubated for the sake of corporate convenience and profit. But why would the patient's doctor order such a thing you ask? The primary treating physician for many nursing home residents also happens to be the facility's staff doctor, who very often also happens to hold a financial interest in the institution. How's that for conflict of interest!

The sabre of conflict of interest was double-edged, and it didn't take long for Mrs. Herbert's opponents to raise it. As commonly would be expected, Mrs. Browning had chosen in her Last Will and Testament to leave, upon her death, her entire estate to her next of kin. Was $250,000 enough money in the till for Mrs. Herbert to "hasten" her cousin's death? The State Attorney thought so. Mrs. Herbert, as well as most other relatives in this position, see their prospective inheritance dwindle away through expensive and seemingly endless medical, hospital, and nursing home "services." According to the State, this potential conflict was serious enough to require families to obtain judicial consent to terminate tube feeding.

Let's have a little trial and invite the State Attorney, just to make sure persons like Mrs. Browning are protected from their loved ones! The State's position was decidedly anti-family and had the condescending and threatening odor of "big brother" seeking to intrude upon highly personal and private areas of citizenry life. Most people expect and believe that a spouse or child or other relative of an incompetent patient is primarily concerned with the loved one's welfare, and is not the sinister, money-grubbing operative portrayed by the State.

Despite Mrs. Herbert's apparent heartfelt plea that the feeding tube be removed because it was the expressed wish of her cousin, she was looked upon with suspicion and derision by the State, Mrs. Browning's doctor, and the nursing home staff. Various employees of the nursing home would sarcastically remark to her, "How can you think of killing your cousin like this?" or, "What kind of person are you who would starve someone to death?" This emotional blackmail and intimidation was commonly inflicted by health care providers upon family members trying to grapple with the heartbreaking decision whether or not to terminate tube feeding.

Obviously, many health care providers are compassionate and dedicated. But even this group sometimes clashed with the family, as each saw the patient quite differently. The contradictory patient assessments made by family and provider are due, in part, to relative perception. The doctor, nurse, social service worker, and aide never knew or observed the patient prior to the medical catastrophe. Their relationship with the patient is therefore limited in context to the reality of impairment, and the spectrum of patient behavior and response they experience is the narrow one with which they are very familiar.

Family and friends, however, have had a lifelong relationship with a vital individual, and now see an incapacitated patient who bears little resemblance to his or her former self. Fine gradations in patient behavior may be irrelevant to the family when their benchmark for comparison is pre-impairment. No wonder viewers from such opposing perspectives may see something differently, or may form contrary beliefs as to what constitutes the best interests of the patient. While this dynamic may partially explain conflicting opinions about patient competence, it doesn't resolve gross discrepancies in observation, nor does it ever excuse the infliction of emotional cruelty.

Why not then just let an impartial judge sort out all these issues and make a fair decision solely based upon the patient's welfare? Aside from all the impediments previously mentioned, the process of obtaining judicial relief is exceedingly slow. Opinion after opinion sang the same refrain. After expounding at length upon the legal theories and social policies that entitle the patient to the relief requested, the court concludes by casually mentioning that the patient died months before the decision was entered! A year or two is nothing in the time frame of litigation. What good is a right to die with dignity, if the remedy for enforcing the right is useless? It became obvious that if the right-to-die were to have any practical effect, these medical treatment decisions had to be made by patient families, after consultation with health care providers, without the requirement of judicial intervention.

As I stood in front of Mrs. Browning reflecting upon these issues, I knew I had not answered for myself the question that brought me here: would I represent Mrs. Herbert and become the agent of Mrs. Browning's death? I had hoped for some help, some sign from Mrs. Browning. Although no closer to what I sought, I remained at her bedside, sensing that my question would somehow be answered before I departed.

[[[ “I felt the mid-section of my body open and noticed a strange quality to the light in the room. I sensed her soul in agony. As she screamed I heard her say, in confusion, ‘Why am I still here … why am I here?’ My soul touched hers and in some way, I communicated that she was still locked in her body. I promised I would do everything in my power to gain the release her soul cried for.”

I don't know if anyone posted anything about this book, but you have to see it to believe it.

I found the man to be very disturbing. I saw him at the hospice while giving press conferences.
Very scary person.

jmho,
Tom

2 posted on 04/04/2005 10:39:06 PM PDT by tacomonkey2002 (a Stranger in a strange world)

This is better reading i'm sure.

Felos is a ghoulish little rodent that has some serious bad karma headed his way

I've read some of his writings and I find the man obsessed with watching people die. I compare him to a Arsonist, who lights the flames that destroys a structure and gets off on watching that structure burn to the ground.

I agree, George Felos is a deeply disturbed man who has the backing of the death cult in this country and they must be confronted head on

4 posted on 04/04/2005 10:57:44 PM PDT by MJY1288 (The Democrats are the party for the death of the innocent and life for the wicked)

To state it simple, HE IS NUTS!

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