The legal right to refuse life-saving or life-sustaining treatment. A competent adult has the legal right to refuse medical treatment, even if that treatment is essential to sustain life. Some refer to this right as the “right to die.” The issue of the “right to die” arises in the situation where a person has a condition in which the quality of life is so intolerable that death, at least in the belief of that individual (or those responsible for that person), is preferable. If the person is conscious (and mentally competent), he or she may exercise the right to refuse treatment for him or herself; but if unconscious or otherwise incompetent, others must make the decision for him or her. Serious legal and ethical issues are involved in the latter case.
The freedom to choose one’s own end-of-life care by specifying, for example, whether one would permit or want life-prolonging treatments (e.g., intubation and mechanical ventilation); intravenous or enteral feedings; antibiotics (if infected); narcotic analgesics (if in pain); or medications to hasten death (e.g., in assisted suicide or euthanasia). The moral, ethical, or legal authority to make decisions about many of these issues is a topic of considerable controversy and confusion. Contemporary health care techniques often permit the prolongation of a patient’s life, when, in the natural course of biological events, that life might have ended. The ability to postpone death, and the difficulty that health care providers have in predicting when death will occur, has generated many questions about the meaning of care and well-being at the margins of existence. Who should make decisions for patients when they cannot speak for themselves? How should one’s wishes be expressed or codified? Who should carry them out if the patient cannot act on his or her own? When must a person’s stated wishes be followed precisely, and when should they be factored in with the wishes of loved ones or of those acting on behalf of the patient? Should they ever be ignored or overruled? When does the aid given to a dying person compromise the moral or professional values of others or jeopardize the legal standing of the patient’s caregiver? Many of these challenging questions remain unresolved.