Florida law creates artificial sustenance dilemma

Although a model statute for its inclusiveness, Florida's 1984 Life-Prolonging Procedure Act excludes "sustenance" from its definition of life-prolonging procedures that may be forgone. The majority legal opinion has held that the law prohibits withdrawing or withholding nutrition and hydration by whatever means they must be provided. Also, a Florida circuit court decision has disavowed the applicability of the argument that extraordinary life-prolonging procedures violate a patient's constitutional rights. An amendment to repeal the sustenance clause failed, making the question of whether to withdraw--or even initiate--artificial feeding an entirely legal decision, rather than a clinical and bioethical one. The act will have enormous effects at long-term care facilities, where elderly and debilitated patients, as well as the terminally ill and comatose patients the statute addresses, may be force-fed against their wishes. Society must decide whether providing nutrition and hydration is "medical treatment" or whether, because it is basic to human life, it cannot be considered as such. To make such a determination, one must understand that feeding technology includes invasive procedures which might be considered extraordinary. The Florida law, however, does not distinguish between degrees of invasiveness. The law demonstrates that resolving clinical and ethical dilemmas through legislation may result in society surrendering the freedom and responsibility that are essential to ethical decision making.