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Joined: 20 Apr 2009
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Location: USA
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Is there a difference between withholding life-sustaining interventions and withdrawing them? No. The consensus is that there is no important legal or ethical difference between withholding and withdrawing medical interventions. Stopping a treatment once begun is just as ethical as never having started it.
TABLE 2-2 -- PRACTICAL CONSIDERATIONS IN TERMINATION OF MEDICAL TREATMENTS
Practical Question Answer
It generally is agreed that all patients have a right to refuse medical interventions. Ethically, this right is based on the patient's autonomy and is implied by the doctrine of informed consent. Legally, state courts have cited the right to privacy, right to bodily integrity, or common law to justify the right to refuse medical treatment. In the 1990 Cruzan case and in the subsequent physician-assisted suicide cases, the U.S. Supreme Court affirmed that there is a “constitutionally protected right to refuse lifesaving hydration and nutrition.” The Court stated that “[A] liberty interest [based on the 14th Amendment] in refusing unwanted medical treatment may be inferred from our prior decisions.” All patients have a constitutional and an ethical right to refuse medical interventions. These rulings were the basis of the consistent state and federal court rulings to permit the husband to terminate artificial nutrition and hydration in the Schiavo case.
What interventions can be legally and ethically terminated? Any and all interventions (including respirators, antibiotics, intravenous or enteral nutrition, and hydration) can be legally and ethically terminated.
Just as proxies are poor at predicting patients' wishes, data show that physicians are probably even worse at determining patients' preferences for life-sustaining treatments. In many cases, life-sustaining treatments are continued even when patients or their proxies desire them to be stopped; conversely, many physicians discontinue or never begin interventions unilaterally without the knowledge or consent of patients or their surrogate decision makers. These discrepancies emphasize the importance of engaging patients early in their care about treatment preferences. |
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