Should food and water ever be withdrawn
or withheld in
order to shorten the process of your dying?
The withholding or withdrawal of artificially-administered
nutrition is one of the most controversial issues
right-to-die debate at the beginning of the 21st century.
The 'living will'
laws of some states explicitly forbid
means of shortening one's dying.
Other states say
that a proxy can only withdraw or withhold
food and water if
the patient has explicitly authorized this.
Most legal observers agree that a state law
cannot take away a
pre-existing right under the common law
—in this case the
right to refuse any medical treatment,
providing food and water by tubes.
So even if you
live in a state that has tried to ban this practice,
you can still
claim it under the common law
and under your
Constitutional right of privacy.
In the Cruzan decision, the US Supreme Court has determined
that states can
require "clear and convincing" evidence
if you want the
termination of life-supports such as food and water.
convincing" evidence is the highest standard used in civil cases.
The Court could
have accepted "fair preponderance" of the evidence,
which is normal in
most civil cases.
But the Supreme
Court decided to err on the side of caution
—to preserve life
unless there is "clear and convincing" evidence
that the patient
would not have wanted to be kept on these life-supports.
As interpreted by the courts, this standard seems to exclude
casual, passing comments you shared
Only serious, reflective discussion
counts as "clear and convincing".
Of course, a
written Advance Directive stating that you do not want
to be kept on
life-supports under clearly defined conditions
would pass this
test of "clear and convincing" evidence.
And if Nancy
Cruzan had had such an Advance Directive,
she would not have spent 8 years
sustained by a feeding tube.
This standard leaves no room for the views of relatives.
Only your own views as the patient
According to the
Supreme Court, your proxies do
not have authority
to disconnect a
feeding tube without your explicit authorization.
You will be safest
if you have an unambiguous Advance Directive
the withdrawal of food and water
when there is no
chance of recovery.
YOUR LAST YEAR: CREATING YOUR ADVANCE DIRECTIVE FOR MEDICAL CARE
Let's draw out the medical situation envisioned here.
We are not talking
about normal eating and drinking.
We do have a
Constitutional right to liberty and privacy
that allows us to
stop eating and drinking if we want to.
Even when we are
not in a hospital or nursing home,
we can make a free
choice whether to eat and drink or not.
The situation you must address in your Advance Directive
is when you are no
longer able to eat and drink normally.
and hydration is being provided to you
either thru a
feeding tube into your stomach or intestines
or directly into
your bloodstream thru a tube inserted into a vein.
Feeding tubes are
a common practice in American nursing homes
when the patients
become too incapacitated to feed themselves
and it is too
time-consuming to feed them by spoon.
swallow normally even when fed by spoon.
persistent vegetative state receive food and fluids by tube
because there is
no way for them to 'wake up' enough to eat normally.
If you are ever in such a state,
do you want to
continue to be sustained by artificial feeding
or do you want to discontinue such means of
supporting your body?
If you choose to
be fed artificially for an experimental period,
how long should
And how should
your proxies decide that continued tube-feeding is futile?
You should be completely clear that if you authorize
the withdrawal or
withholding of food and fluids,
you will die within a short time—a
week or ten days.
Withdrawal is now
the most common means of merciful death in the US.
It is justified
under the right to refuse medical treatment.
And when you are
receiving food and water thru tubes,
have ruled this is a form of medical
When you are in a condition to need artificial feeding,
you will probably
not be capable of making medical decisions.
withdrawal decision will have to be made by your proxies.
And they will want
to know as completely as you can explain it
in your Advance
Directive just what you would want,
what limits you
would put on the decision, etc.
illustrate your choice by hypothetical examples
of conditions in
which you would want
to be sustained by feeding tubes
and conditions in
which you would not want
to be sustained.
15: WITHDRAWING FOOD AND
WATER by JAMES
You could choose never
to approve the removal of a feeding tube.
You can request
that all such life-supports remain in place
until you die
despite the "tubes and machines".
A middle path might be: choosing to be kept
feeding and hydration until the family can be assembled,
life-supports would be withdrawn, resulting in your death,
which would be
followed by your funeral or memorial service.
Remaining on feeding tubes will extend your dying process.
But you might have
moral or religious reasons
for saying that
nothing should be done that would shorten your life.
If you are senile
or unconscious while attached to feeding tubes,
it will no longer
matter to you whether
you are dead or alive,
but it might be
important to your loved ones
to keep your body
'alive' as long as possible.
The withdrawal of
food and water might be difficult for them.
Perhaps you and
the people who are closest to you
will be able to
create a compromise between
those who want an
early end to tube-feeding
and those who want
to maintain life-supports as long as possible.
If some of your proxies would never approve a life-ending decision
—perhaps for moral
or religious reasons—
and you want
withdrawal of food and water if you will never recover,
then you should
appoint a sub-committee of your MCDC
authorize this and/or other life-ending decisions.
selection above is the full Question 15 from the book:
Year: Creating Your Own Advance Directive for Medical Care.
this title, you will see
the complete table of contents.
would like to see one person's Answer to this Question,
go to James
Park's Advance Directive for Medical Care.
Scroll down to Answer 15.