The controversy and concerns surrounding withholding nutrition and fluids in the clinical circumstances discussed herein have also extended to the courts. To the extent that death is predictable in a period of hours, days, or even weeks, these intellectual and emotional struggles are less intense. This is less likely to be the case in patients with terminal disorders in whom the timing of death is less certain or in PVS patients who might live for years with artificial feeding. As a result, disagreement has spilled over into the legal system. Subsequent judgments have provided legal support for the following concepts:
1. Artificial feeding is medical treatment, and can be viewed on a level with other life-sustaining interventions (mechanical ventilation, dialysis, antibiotics, etc.).
2. Competent patients may refuse life-sustaining treatment and this is a right also afforded to incompetent patients, particularly when there has been prior indication of this desire. State interests do not trump these rights.
3. Withholding and withdrawing life-sustaining treatment, including artificial feeding, are equal under the law. There is no requirement to continue a treatment once started if the proportionality of benefits and burdens is unfavorable.
4. Withholding or withdrawing life-sustaining treatment in a patient with terminal disease is neither killing nor euthanasia.
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