Legal Aspects of Life Support In "Legal Aspects of Withholding and Withdrawing Life Support from Critically Ill Patients in the United States and Providing Palliative Care to Them," authors John M. Luce and Ann Alpers, present this article to increase an understanding of the legal obligation of physicians and practitioners.
Studies have shown that most patients, who die in intensive care units in the United States, deaths are related to the withholding and withdrawal of life support and also the administration of palliative care. The process through which various medical interventions are withheld or removed from patients with the expectation that the patient will die of an underlying illnesses is withholding and withdrawal of life support. The prevention or treatment of pain or providing comfort during suffering in terminally ill patients is palliative care. Physicians and practitioners are bound by ethical principles of autonomy, beneficence, and nonmaleficence. This means their actions are done for the benefit of others and they must do no harm.
There are laws that govern the legal aspects and requirements of these practices in which physicians and other practitioners may not be familiar. The limitations of life sustaining treatments vary from each state and are based on statutory and case law. The Fourteenth Amendment to the Constitution protects a competent person’s right to proceed with treatment which includes nutrition and hydration. The legal aspect of withholding and withdrawing life support is legally justified by informed consent and informed refusal in the United States. These principles state that the approval of the patient or surrogate is needed in order for treatment or refusal to be initiated. The only exception to this principle is in an emergency situation. Another legal aspect of withholding and withdrawing life support is futility, which refers to interventions that are unlikely to produce any significant benefit for the patient. In some cases involving futility, courts have intervened when the families choose treatment and the physician opposes treatment. In this case, the legal rule required to measure a physician’s treatment decision against the standard of medical care is the malpractice test.
The legal aspect of providing palliative care was and approved by the Supreme Court. Courts set guidelines so that no healthcare professional is permitted to assist with a suicide. The Pain Relief Promotion Act of 1999 was drafted by Congress to promote pain management and palliative care without allowing assisted suicide. This act allows physicians to administer sedatives and analgesics to dying patients, which could increase the risk of death, but it prohibits intentionally administering controlled substances for the purpose of assisted suicide.
In satisfying the legal requirements, the Pain Relief Promotion Act can still be challenged in that it interferes with state’s rights. One positive outcome for physicians and practitioners is that the bill has been supported by the American Medical Association. The withholding and withdrawal of life support and the administration of palliative care usually involves the physician and other practitioners and all parties should be involved in the planning of treatment. Physicians and practitioners should always act on what they believe to be in the best interest of their patient.

Works Cited

Luce, John M, and Alpers, Ann. “Legal Aspects of Withholding and Withdrawing Life Support from Critically Ill Patients in the United States and Providing Palliative Care to Them.” American Journal of Respiratory Critical Care Medicine vol 163 (2001): 2029-2032 http://ajrccm.atsjournals.org/content/162/6/2029.long