Useful guidelines for making those anguished decisions on withholding or withdrawing life-sustaining supports for terminally ill patients have emerged from a 2 1/2-year study by national experts under auspices of the Hastings Center in New York.
The new study makes a clear distinction between, on the one hand, suicide and mercy killing, which "our society properly forbids," and the refusal of life-sustaining treatment in certain circumstances, which is gaining wider and wider support. That is helpful, for some critics have complicated matters by failing to distinguish between efforts to prolong life and applications of medical technology that serve primarily to prolong dying.
The report emphasizes the right of the patient, or the patient's surrogate, to make the decisions regarding life-sustaining interventions, including food and water. This points to the importance of anticipating crises through a living will to make specific provision for deciding when to refuse life-sustaining treatment. The most difficult situations arise when a patient is no longer competent to make a decision and has no surrogate.
In discussing treatment, the report brings a fresh perspective by underscoring the importance of consent. Consent is required for bodily invasion, including "all forms of artificial nutrition and hydration, including nasogastric tubes and intravenous lines." The panel also argues that the patient or surrogate "should be able to forgo antibiotics and other life-sustaining medication," noting that "the burdens of such medication sometimes outweigh the benefits from the patient's perspective."