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PubMed1985

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.

Catholicism↗
PubMed1990

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.

Enteral Nutrition↗