Position statement on laws and regulations concerning life-sustaining treatment, including artificial nutrition and hydration, for patients lacking decision-making capacity

Abstract

We read the article by Bacon et al. with interest.1 The authors addressed the legislation in the United States for patients who are incapable of making medical treatment decisions and the effects that these laws can have on patients’ rights to self-determination. In 2006, detailed and presumptive legislation was proposed in several states declaring that without a thoroughly written advance directive, patients who are legally incompetent will receive artificial nutrition and hydration (ANH).1 This complex legislation increased the chance of a patient’s wishes being overturned. In contrast, there are several states in which legislation has been proposed to facilitate the use of advance directives. By improving education, standardizing forms, and adding advance directives to public identification cards, these states have made treatment decisions less controversial. The American Academy of Neurology (AAN) has reissued a statement that is in agreement with this less presumptive legislation. It opposes all legal/judicial interference with private decisions regarding ANH and medical treatment, and they support those options that make advance directives more appealing and useful within our society. Several studies have shown the impact of early education on behavior outcomes. For example, it has been shown that a multicomponent approach to educating adolescents about drugs, alcohol, and violence is correlated with reduction in the use of illicit …