Withdrawal of or Withholding Medical Treatment

An individual has a constitutional right to request the withdrawal or withholding of medical treatment, even if to do so will result in the person's death. Honoring a person's right to refuse medical treatment, especially at the end of life, is the most widely practiced and widely accepted right to die policy in our society. Most medical, legal, and ethical authorities agree that no ethical distinction exists between an individual's request to have life-sustaining treatment removed and a request to withhold this treatment.

An individual's right to refuse treatment is still valid when he or she becomes incompetent. All 50 states authorize the use of a written advance medical directive to help honor the decisions of those who are not able to speak for themselves but who have recorded their wishes in an appropriate legal document. The living will and the medical power of attorney are examples of these documents.

Competence Defined

Many operational definitions of competence have been proposed, but non has universal acceptance. The US President's Commission on Ethics in medicine suggested that competence requires all of the following:

The ability to communicate
The ability to understand information
The ability to reason and elaborate
The ability to choose
Consistency between one's choices and one's underlying values

Karen Quinlan

April 15, 1975 - 21 year old in alcohol and drug induced coma
Irreversible brain damage - persistent vegetative state
Put on respirator and fed through feeding tube
5 months later - parents wanted to remove respirator
Hospital would not allow
Case went to court
November 10, 1975 - New Jersey Superior Court denied parent's request
NJ Supreme Court subsequently decided that Rrefusal of life-saving treatment fell under the constitutional right to privacy - physician may remove her from respirator
Slowly removed from the respirator
Died in 1985 from pneumonia

Nancy Cruzan

January 11, 1983 - 25 year old, crashed her car
Was left brain damaged
Oxygen deprivation caused deep coma - persistent vegetative state
Artificial nutrition and hydration supplied through feeding tube (no ventilator)
Left no written instructions regarding her end-of-life wishes
Parents requested to have tube removed
Case went to court
Initial court decision was to preserve life

Cruzan family appealed the decision - June 25, 1990 US. Supreme Court recognized the right to die as a constitutionally protected liberty interest

Clear and convincing evidence of patient's will to die needed before action could be taken
Testimony of friends provided clear and convincing evidence of Nancy's will to die
Courts ruled that Nancy Cruzan had right to die
Tubes removed December 14, 1990
Died 11 days later