|Foregoing artificial nutrition and hydration has come to be widely accepted as a legitimate option under state law. A survey of how the 50 states (and D.C.) view this issue is provided here (with citations to statutes and court cases in each state).
Key principles to keep in mind regarding the law . . .
- ALL states recognize the competent patient's right to forgo medical treatment of any kind (including artificial nutrition and hydration), at any time, regardless of the patient's condition or prognosis.
- ALL states recognize the right of an incompetent patient to have his or her previously expressed wishes regarding medical treatment followed, regardless of the patient's condition or prognosis. The only important difference among the states is the level of evidence that is required to establish what a patient's wishes would be for his or her present situation.
Most states allow the closest family member to authorize the withholding or withdrawing of life-sustaining treatment (including artificial nutrition and hydration) based on the concept of substituted judgment, where the decision is based on the patient's value system and general outlook on life.
Some states (New York and Missouri, for example) require more explicit expressions of preference (often referred to as clear and convincing evidence) before life-sustaining treatment (especially tube feeding) can be withheld or withdrawn.