A woman lies in an irreversible coma for two years. She has left no clear end-of-life instructions. There is a dispute over whether she should be allowed to die of thirst and starvation. Terri Schiavo? No, Janet Rivera, a 46-year-old California woman has been unresponsive since a heart attack two years ago. With bills mounting up and no clear family leadership, the Fresno Count Public Guardian stepped in and pulled the plug, removing her ventilator and the tubes which supplied her with food and water. The decision was initially supported by her family.

But Mrs Rivera continued to breath without assistance, to everyone’s surprise. At that point family members requested that she be restored to life support so that she would not starve to death. Fresno County refused and the family, supported now by a team of legal experts, mounted a challenge. After Mrs Rivera had languished without food and water for 11 days, the county guardian stepped aside in favour of her cousin, Suzanne Emrich, and she went back onto life support.

Although the Rivera case resembles that of Terri Schiavo, who eventually starved to death in 2005, there are differences. In the Schiavo case family members were divided about her views on end-of-life care. The Rivera case pits her family against the local government. One wants her to stay alive and the other wants her to be allowed to die. At stake is who should be allowed to make the decision: family or bureaucrats? A hearing next Tuesday in Fresno County Probate Court will determine whether Mrs Rivera remains on life support. It is quite possible that she will, as the California Supreme Court has ruled at least once that a public guardian should have a clear understanding of a patient's wishes in order to end life support.

One complicating factor is that Mrs Rivera’s family ties appear to be very weak. Local newspapers allege that her husband seriously neglected his wife’s care and allowed her health insurance to lapse. Other relatives were not closely involved until the situation became critical. ~ Fresno Bee, July 29