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Some U.S. States Seek to Change Life Support Laws

Some want to place burden on patient representative to show that life support should be withdrawn

THURSDAY, May 11 (HealthDay News) -- More than two-thirds of U.S. states allow patients or their representatives to decide whether to withdraw life-sustaining treatment when the patient is in a persistent vegetative state, according to a report published in the June issue of Neurology. However, laws and proposed legislation in some states may force the burden on the patient's representative to show that life support should be withdrawn and reverse 30 years of law and health care ethics, the authors write.

Dan Larriviere, M.D., J.D., and Richard J. Bonnie, L.L.B., from the University of Virginia in Charlottesville, searched the Lexis-Nexus and Westlaw legal databases to review the laws regarding the right to terminate life-sustaining treatment by refusal of artificial nutrition and hydration for patients in a persistent vegetative state. The study was undertaken as a result of the controversial Florida case in which Terri Schiavo's husband and legal guardian wished to withdraw her life support.

The researchers found that in more than two-thirds of states, patients, their proxies and surrogate decision-makers could decide whether to withdraw or withhold feeding without judicial intervention if the patient was in a persistent vegetative state. However, they note that in some states either a persistent vegetative state is not among the clinical conditions allowing withdrawal of life-sustaining treatment or an advance directive is required before treatment can be withdrawn. Requiring an advance directive may be unconstitutional, according to the authors.

Some states have proposed legislation presuming that artificial nutrition and hydration should be continued and place the burden on the surrogate decision maker to rebut that presumption, they note. "Such a turn of events would put patients, their families, and their physicians in the same place we all were 30 years ago -- dispensing judicially mandated treatments despite the protestations of patients (via the proxy or surrogate decision maker), their families, and their physicians," Larriviere and Bonnie write. "As such, these statutes represent a reversal in the direction of the law and health care ethics over the past three decades."

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