Patient's right to refuse life sustaining treatment

Avninder A.

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Patient's right to refuse life sustaining treatment

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Abstract

Medicine and law overlap in regards to numerous issues, none more controversial than a patient's right to refuse life sustaining treatment. When a patient is suffering an incurable and irreversible medical condition they face the extremely difficult decision of whether or not to continue treatment. The law has not been silent on this issue, yet are many factors are involved when a patient decides to end treatment. In New York, competent patients have the right to refuse any type of medical treatment, and the Federal Patient Self Determination Act requires Medicare and Medicaid institutional providers to inform patients of their rights . The right to refuse treatment is based on the Constitutional right to autonomy as well as the common law right to self determination. Any competent patient may exercise this right for a plethora of interpersonal reasons. Yet this right poses controversial ethical issues for patients, their families and their physicians. Life sustaining treatment is defined as any medical intervention, technology, procedure, or medication that forestalls the moment of death, whether or not the treatment affects the underlying life threatening diseases or biological processes. Since there is always some type of treatment available for a patient, the question remains when does one choose to stop fighting death, and for what reasons

Introduction
History of a patient's right to refuse medical treatment
Conflict with the physician's interest in preserving life
Withdrawing versus withholding treatment
Conflict in withdrawing artificial nutrition
Decision making process
Who decides for incompetent patients?
Rights of minors
Rights for patients with mental deficiencies
Recent rulings: The case of Terri Schiavo
Distinction of physician assisted suicide
Conclusion

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Extract

[...] In addition, the policies for the removal of life sustaining treatment do not apply to brain death. Once a patient is diagnosed as brain dead the hospital may discontinue treatment at any time subsequent to informing the patient's family. Conflict in Withdrawing Artificial Nutrition Another controversial issue is whether or not there should be a distinction for withdrawing artificial nutrition. Artificial nutrition serves as a supply of food and nutrients to the patient through an intravenous tube. Several court cases have established that it is justifiable to withhold or withdraw artificial nutrition and hydration, yet this issue remains the subject of debate. [...]

[...] In New York every competent adult has the right to accept or refuse medical treatment including all treatments necessary to sustain life. Furthermore, each patient also has the right to appoint a proxy to make treatment decisions on their behalf in the event the patient is not capable of making decisions himself. A patient may appoint someone as a surrogate by filling out a Health Care Proxy to plan in advance of the possibility of not being able to make treatment decisions himself. [...]

[...] Nonetheless, the issue of the withdrawal of life sustaining treatment continues to raise debate, especially with its ties to the present debate over physician assisted suicide. Distinction of Physician Assisted Suicide Although courts have reaffirmed the constitutionally protected right to bodily integrity in situations regarding life sustaining treatment, this right has not been extended to physician assisted suicide. Proponents of legalizing physician assisted suicide argue that there is no moral difference between withholding life sustaining treatment and providing a patient with the means to end their life. [...]

[...] The doctrine of substitute judgment provides that an incompetent patient's right to refuse treatment may be exercised through a surrogate decision maker who has a duty to carry out the patient's wishes as closely as possible. In determining the patient's surrogate decision maker the law recognizes a hierarchy of legal relationships: legal guardian with health care decision making authority, individual given durable power of attorney for health care decisions, spouse, adult children of the patient (all in agreement), parents of the patient, and finally adult siblings of the parent (all in agreement) The person appointed then has the duty to act in the best interests of the patient in making treatment decisions. [...]

[...] Recent rulings: The Case of Terri Schiavo The issue of the right to withdraw life sustaining treatment has received added attention in the past year due to the case of Theresa Marie Schiavo. The previous cases of In re Quinlan and Cruzan have affirmed the right of a patient to refuse life sustaining treatment, even in the event the patient is unable to make the decision for herself. For Ms. Schiavo it seemed as if the controversy was politically motivated, rather than conflict of interest between the family's decision and the health care provider's recommendation. [...]

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