Saturday, 25 May 2013

Emedinews:Insights on MEdicolegal Issues:The right to refuse medical interventions - The Nancy Vehicle Accident Case

The US Supreme Court declared that artificial hydration or nutrition is no different from medicines

Nancy Cruzan, a 31–year–old woman suffered severe brain damage in a vehicular accident that placed her in a persistent vegetative state, dependent upon a feeding tube.
  • After four years without improvement in her cognitive function, her family asked to have her artificial feeding and hydration stopped.
  • In its decision, the United States Supreme Court recognized that competent patients have a constitutional right to refuse medical care.
  • Using the Fifth Amendment’s guarantee that no person shall "be deprived of life, liberty, or property, without due process of law" the Supreme Court affirmed patients’ rights to refuse medical treatments. The Court declared that artificial hydration or nutrition is no different from other medical interventions. Although mentally incapacitated patients have the same right, the Supreme Court allowed states to impose restrictions on how explicit and specific the patient’s prior wishes had to be.
  • After this court ruling, some of Cruzan’s friends provided evidence that she had previously expressed wishes that she would want artificial feedings discontinued in such a scenario. As a result of this testimony, her feedings were terminated.
  • Mentally competent patients need not be terminally ill to exercise this right to refuse interventions they have the right regardless of health status.
  • The right applies equally to withholding proposed treatments and to discontinuing initiated treatments.
  • The right to refuse medical care does not imply a correlative right to demand treatment.

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