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Refusing artificial nutrition and hydration: does statutory law send the wrong message?

Carol E Sieger1, Jason F Arnold, Judith C Ahronheim

  • 1Partnership for Caring, New York, NY, USA.

Journal of the American Geriatrics Society
|April 12, 2002
PubMed
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Refusing artificial nutrition and hydration (ANH) faces legal hurdles in some states, despite ethical consensus. Statutes in 39% of states impose stricter rules for ANH refusal in incapacitated patients.

Area of Science:

  • Medical Ethics
  • Health Law
  • Bioethics

Background:

  • Ethical consensus and court decisions generally classify artificial nutrition and hydration (ANH) as medical treatment.
  • Advance directive statutes may create barriers to refusing ANH for incapacitated patients.

Purpose of the Study:

  • To review state statutes and appellate case law on ANH refusal for patients lacking decision-making capacity.
  • To identify legal obstacles to ANH refusal compared to other treatments.

Main Methods:

  • Analysis of state statutes concerning medical decision-making for incapacitated patients.
  • Review of appellate court decisions related to ANH refusal.

Main Results:

  • Twenty states (39%) have explicit statutes imposing stricter standards for ANH refusal.
Keywords:
Death and EuthanasiaEmpirical ApproachLegal Approach

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  • These stricter standards include higher evidentiary requirements, preauthorization, specific conditions, second opinions, or judicial review.
  • Some statutes contain ambiguous language that could imply higher standards for ANH refusal.

    • Conclusions:

    • Higher statutory standards for ANH refusal may impede patient autonomy and burden healthcare providers.
    • Legislators and courts should re-evaluate these stricter standards in light of established legal principles and common law rights.
    • Ensuring consistent legal treatment of ANH refusal is crucial for patient care and provider confidence.