Decisions to abate life-sustaining treatment for nonautonomous patients: ethical standards and legal liability for physicians after Cruzan

Article Abstract:

Although physicians may fear legal reprisals if they cease to provide life-sustaining treatment to critically ill nonautonomous patients (who lack the capacity to make decisions), in reality, they are not likely to be found liable. Ethical and legal aspects of possible physician liability are evaluated in the aftermath of the recent Supreme Court decision regarding Nancy Cruzan, a young woman in a persistent vegetative state (PVS). Cruzan would not live if she were not maintained with technological feeding and hydration; her parents requested that this sustenance be withdrawn. Hospital staff refused, precipitating a legal action that found its way to the Missouri Supreme Court, where the decision was handed down that the family cannot choose to abate treatment for an incompetent person without clear and convincing evidence of the person's wishes. The US Supreme Court upheld this decision. However, the decision has no direct impact on statutory law in 41 states and the District of Columbia, which have enacted natural death acts; nor will it affect case law in 29 jurisdictions that addresses the rights of nonautonomous people to refuse treatment. Case law in these states is reviewed to determine possible ethical and legal liability. Topics include the right to refuse life-sustaining treatment; the role of surrogates; laws relating to specific medical conditions, such as cancer or quadriplegia (paralysis of arms, legs, and, usually, the trunk); the types of treatment that may be abated; individual rights versus state interests; and the threat of legal liability. In every court of final decision in every jurisdiction, physicians who participated in abating life-sustaining treatment have been found free from liability. On the other hand, physicians who do not honor their autonomous or nonautonomous patient's wish to abate treatment have faced malpractice or related charges. Physicians who abate life-sustaining treatment that is known or judged to be contrary to a nonautonomous patient's wishes have little to fear. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, Laws, regulations and rules, Physician and patient, Physician-patient relations, Cruzan, Nancy

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The physician can play a positive role in euthanasia

Article Abstract:

Active euthanasia cannot be supported on any grounds, and the writer does not believe that euthanasia can or should be required of a physician as a duty. However, the physician should be allowed the right to assist the competent, terminally ill patient who has freely decided to end his life. Physicians often consider themselves to be healers, fighting against death each day. This perspective often prevents physicians from understanding that they have other roles as well. One of these is the amelioration of pain. Recent trends such as living wills and 'do not resuscitate' orders were unthinkable only a few years ago. All living beings die. Are there not cases where death is more humane?

Interpretation and construction, Euthanasia, Medical ethics, editorial

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