Withdrawal and withholding of life-supporting food and fluids. One state's struggle

In the last two decades medical and social changes have occurred to shift the focus from the dying patient to the chronically impaired, from voluntary to involuntary and from euthanasia to withholding/withdrawal of life-prolonging treatments. Acceptance by the courts of various theories and devices, such as "surrogate" decision-makers, medical/judicial review and living wills, has extended the patient's constitutional right of privacy to justify termination of life supports to allow a natural death. The AMA's Council on Ethical and Judicial Affairs in 1986 included artificially supplied nutrition and hydration in its definition of life-prolonging medical treatment. Currently, state legislatures and the courts are struggling with the task of balancing the extent of patient autonomy and the state interest in preservation of life. In the rush to acknowledge the quality of life, the sanctity of life must not be discarded. Comprehensive legal reform in this area must strengthen the legal rights and obligations of both patients, their families and physicians.