Terminating artificial nutrition and hydration in persistent vegetative state patients

This article presents an overview of current state law governing the right to terminate life-sustaining treatment in the United States as it relates to refusal of artificial nutrition and hydration (ANH) for patients who have been diagnosed as being in a persistent vegetative state (PVS).

The article was stimulated by the efforts of Michael Schiavo, Terri Schiavo’s husband and legal guardian, to discontinue ANH for her, and the ensuing controversy. Like many other neurologists, lawyers, and ethicists, we assumed that the law governing withdrawal of ANH in patients diagnosed as being in a PVS had become relatively settled and that the prolonged litigation occurring in Florida was the exception rather than the rule.^1,2 We reviewed state laws to ascertain whether this assumption was indeed accurate.

Scope.

End-of-life decision making is largely governed by state law, although the states’ prerogatives are subject to federal constitutional constraints ultimately enunciated by the US Supreme Court. Our analysis focuses mainly on patterns and variations in state statutes and does not encompass a comprehensive review of case law. Fortunately, in the present context, the statutes in most states provide fairly clear guidance to physicians and hospitals about whether ANH may be withdrawn from a patient in a PVS, and there is little need for resort to case law in most states to clarify their meaning.

Methods.

We used Lexis-Nexis and Westlaw legal databases to conduct a search of all state laws governing end-of-life decision making. We used the following search terms: permanent vegetative state, persistent vegetative state, artificial nutrition and hydration, advance directive, living will, health care power of attorney, coma, unconscious, terminally ill, terminal condition, surrogate, and proxy. We reviewed all statutes that contained any of the search terms and saved for analysis …