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The tragic case of Terri Schiavo raised to public consciousness the issue of whether a lawful surrogate is empowered to refuse artificial hydration and nutrition (AHN) on behalf of a patient in a persistent vegetative state (PVS) based on preferences she orally expressed while competent. Thoughtful commentators pointed out that decisions by surrogates in such cases are constrained by the accuracy of medical diagnosis and prognosis and by the degree of confidence that the surrogate is expressing the true wishes of the patient.1 However, some also raised the question of whether it is ever ethically acceptable for physicians to order withdrawal of AHN.
Medical practice standards, ethical guidelines, and law support the right of patients to refuse life-sustaining therapies in specified circumstances.2,3 This right was clearly articulated by the US Supreme Court in the Cruzan case in 1990.4 The justices determined that the choice of a person in a PVS to decline life support is a protected liberty interest under the 14th amendment to the federal constitution, and that …
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Letters: Rapid online correspondence
- The controversy over artificial hydration and nutrition
- The controversy over artificial hydration and nutrition
- Reply from the Authors
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