Hostname: page-component-7479d7b7d-t6hkb Total loading time: 0 Render date: 2024-07-14T01:44:47.493Z Has data issue: false hasContentIssue false
  • English
  • Français

Neurologic Syndromes and Prolonged Survival: When Can Artificial Nutrition and Hydration Be Forgone?

Published online by Cambridge University Press:  29 April 2021

Ronald E. Cranford
Get access Rights & Permissions [Opens in a new window]

Extract

A recurring lesson in the debate about forgoing life-sustaining treatment for patients with neurologic syndromes is the need to understand the medical realities in such cases. Those of us in the neurological sciences spend a great deal of time working with these cases on a daily basis—trying to define the medical facts and educate ourselves, the public, and the courts. This article will discuss the medical and neurological facts regarding patients with severe and permanent neurological impairment, focusing only on one form of medical treatment: artificially administered nutrition and hydration. The concern of this paper is not the patient's wishes, the family's wishes, or the decision-making role of other key players, but the medical conditions in which it is ethically appropriate to withdraw or withhold artificial fluids and nutrition.

Type
Article
Information
Law, Medicine and Healthcare , Volume 19 , Issue 1-2 , Spring Summer 1991 , pp. 13 - 22
Copyright
Copyright © American Society of Law, Medicine and Ethics 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cranford, Ronald E.. “The Persistent Vegetative State: The Medical Reality (Getting the Facts Straight),” The Hastings Center Report, 18 (February/March 1988), 27–32.Google Scholar
“Guidelines on the Termination of Life-sustaining Treatment and the Care of the Dying: A Report by the Hastings Center.” Briarcliff Manor, N.Y.: Hastings Center, 1987.Google Scholar
Meisel, Alan, The Right to Die (New York: Wiley Law Publications, 1989), 1991 supplement.Google Scholar
Brian, Jennett Fred, Plum, “Persistent Vegetative State After Brain Damage,” The Lancet, 1 (April 1972), 734–737.Google Scholar
Plum, Fred Posner, Jerome B., Diagnosis of Stupor and Coma (F.A. Davis and Company: Philadelphia, 1966), 93.Google Scholar
Ronald, Cranford E. Smith, H.L., “Some Critical Distinctions between Brain Death and the Persistent Vegetative State,” Ethics in Science and Medicine, 6 (1979), 199–209.Google Scholar
Dougherty, John H. Jr Rawlinson, Donald G. Levy, David E. Plum, Fred, “Hypoxic-ischemic Brain Injury and the Vegetative State: Clinical and Neuropathologic Correlation,” Neurology, 31 (August 1981):991–997.Google Scholar
Council on Scientific Affairs and Council on Ethical and Judicial Affairs, “Persistent Vegetative State and the Decision to Withdraw or Withhold Life Support,” JAMA, 263 (January 19 , 1990):426–430.Google Scholar
“Position of the American Academy of Neurology on Certain Aspects of the Care and Management of the Persistent Vegetative State Patient,” Neurology, 39 (1989):125–126.Google Scholar
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, “Deciding to Forego Life-Sustaining Treatment,” Washington DC: U.S. Government Printing Office, (March 1983), 171–192.Google Scholar
Alberico, Anthony M. Ward, John D. Choi, Sung C. et al “Outcome After Severe Head Injury: Relationship to Mass Lesions, Diffuse Injury, and ICP Course in Pediatric and Adult Patients,” Journal of Neurosurgery, 67 (1987): 648–656.Google Scholar
Arts, W.F.M. Van Dongen, S.F. Vanhof-Vanduin, J. Lammens, E., “Unexpected Improvement after Prolonged Posttraumatic Vegetative State,” Journal of Neurology, Neurosurgery, and Psychiatry, 48 (1985):1300–1303.Google Scholar
Steinbock, Bonnie, “Recovery From Persistent Vegetative State? The Case of Carrie Coons,” Hastings Center Report, 19 (July/August, 1989):14–15.Google Scholar
Personal communication, Tad Pula, M.D., Nov., 1986.Google Scholar
Brophy v. New England Sinai Hospital, Inc., Commonwealth of Massachusetts (The Trial Court, Norfolk Division, Docket No. 85E0009-G1), Judge Kopelman, David H., p. 29.Google Scholar
May, William E. Barry, Robert L. Griese, Orville et al. “Feeding and Hydrating the Permanently Unconscious and Other Vulnerable Persons,” Issues in Law and Medicine, 3 (1987): 207.Google Scholar
Barry, Robert L., “The Ethics of Providing Life-Sustaining Nutrition and Fluids to Incompetent Patients,” The Journal of Family and Culture, 1 (Summer, 1985): 25–34.Google Scholar
Barry, Robert L., “Closing the Circle: Humanae Vitae and Feeding the Comatose,” Homiletic and Pastoral Review, (July, 1986) 56.Google Scholar
O'Malley, Padraig, Biting at the Grave: The Irish Hunger Strikers and The Politics of Despair (Beacon Press: Boston, 1990), 113–115.Google Scholar
Cruzan v. Director, 110 S. Ct. 2841 (1990), Amicus Curiae Brief to U.S. Supreme Court, American Academy of Neurology, Minneapolis, MN (1990).Google Scholar
Brophy v. New England Sinai Hosp., Inc., 398 Mass. 417, N.E.2d 626 (1986), Amicus Curiae Brief to Massachusetts State Supreme Court, American Academy of Neurology, Minneapolis, MN (1986).Google Scholar
In re Conroy, 98 N.J. 321, 486 A.2d 1209 (1985).Google Scholar
Cranford, Ronald E. Smith, David R. “Consciousness: The Most Critical Moral (Constitutional) Standard for Human Personhood,” American Journal of Law & Medicine, 13 (1987):(233–248); Medical Task Force on Anencephaly, “The Infant with Anencephaly,” New England Journal of Medicine, 332, (1990): 669–674.Google Scholar
Satz v. Perlmutter, 362 So. 2d 160 (Fla. Dist. Ct. App. 1978), aff'd, 379 So. 2d 359 (Fla. 1980).Google Scholar