PHILADELPHIA, PA — Marshall Klavan, a doctor at Crozer-Chester Medical Center, wanted to die. He said so in notes he wrote just before attempting suicide in his office two years ago.

His fellow doctors at the hospital didn't let him, and he remains alive, but in a vegetative state.

Yesterday, the guardian for Klavan sued the hospital and some of its doctors and other employees in federal court, saying they kept their former colleague alive against his wishes.

Colleagues ignored Dr. Klavan's written instructions not to attempt to save his life.

Specifically, the suit says, the defendants ignored an advanced medical directive Klavan had drawn up four years before he tried to kill himself.

The suit, which contends that Klavan's civil rights were violated, was brought by lawyer Jerome J. Shestack as guardian for Klavan. It asks for damages in excess of $100,000. James Griffith, attorney for Klavan and Shestack, could not be reached for comment. Neither could Crozer-Chester officials.

Klavan had a deep fear of having a stroke and being totally disabled.

Klavan, now 67, was chief of obstetrics and gynecology at Crozer-Chester and lived in the Media area. He attempted suicide after writing what the lawsuit described as "several very detailed, loving notes" to his wife, their children and a close family friend on April 29, 1997.

The next morning, he was found cold and unconscious in his office by hospital employees.

In 1993, Klavan drew up the advanced medical directive, saying that under certain circumstances he did not want extraordinary measures taken to save his life, the lawsuit said. In particular, Klavan had a deep fear of having a stroke and being totally disabled — a condition his father had suffered.

After Klavan was found at his desk, where there were also notes saying he did not want to be resuscitated, he was taken to the emergency room where doctors worked to save his life, according to the suit.

A few days later, on May 2, Klavan's lawyer and family told the hospital about the wishes he had expressed four years earlier in his directive, the lawsuit said. Shortly after that, on May 4, some doctors agreed to abide by Klavan's wishes and reduced his level of care, the suit said.

Lifesaving efforts turned him into a vegetable — exactly what he'd hoped his suicide would thwart.

On May 5, Klavan's condition worsened and except for extraordinary medical efforts, he would have died, the suit said.

That night, doctors met with hospital president Joan Richards and the next day consulted with a hospital lawyer, and were advised to ignore Klavan's 1993 directive, the suit said. After several medical procedures — including intubation and ventilation — were performed on Klavan to resuscitate him, he eventually suffered a stroke that has left him incapacitated, unable to speak or communicate — "the one condition he feared the most," the suit said.

So far, the costs for taking care of Klavan have reached $200,000 and are expected to be $100,000 a year at today's rates, the suit said. Klavan's life expectancy, according to the suit, is 18 more years.


The right to die is not absolute. The right is balanced against the state's interest in protection of third parties, prevention of suicide, and protection of the ethical integrity of the medical community and preservation of life.... Society has not reached the point where medical caregivers' well-meaning efforts to save a professional colleague's life are regarded as indecent, atrocious and intolerable."

On this basis federal judges in Philadelphia dismissed Klavan's "wrongful life" suit against Crozer-Chester (CCMC) on Aug. 16. They also ruled that Klavan could assert his claim that CCMC violated his 14th Amendment right to refuse "unwanted medical treatment" only against a "state actor" — a federal, state or local government or organization closely linked to a governmental function. Although it receives federal funds, CCMC failed to meet the judges' definition of a state actor.

Klavan is now conscious, but remains unable to move or speak.

Lastly, they ruled that questions regarding any duty CCMC had under state law to comply with Klavan's will would have to be decided in Pennsylvania state courts. But that decision is not likely to be soon in coming.

Meanwhile, Klavan is now conscious but remains unable to move or speak, which means that his family cannot obtain a court order to remove his life support, since he is no longer in a "comatose or persistent vegetative state." Klavan is still expected to live in this condition for at least 18 years. With hopes of a court victory all but completely extinguished, his family will be hard pressed to finance the costs of his expected $100,000 yearly care.

from the Philadelphia Inquirer, Aug 8, 1999.


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