What legal procedures are involved in switching off life support?


What legal procedures are involved in switching off life support?


Unfortunately, many individuals have not fully planned and made important end-of-life decisions for themselves, often leaving loved ones struggling to determine what the dying patient would have wanted.

The best course of action is to plan ahead. With a little careful planning, you can provide written and legal directions regarding how you want to be cared for if you are in a coma, have dementia or are terminally ill. More importantly, you can reduce conflict and eliminate the difficulty of making others decide when to end your life.

What is life support?

Life support can include a variety of techniques, medical treatments or medical interventions that can be used to sustain life after the failure of one or more vital organs. Additionally, the distinction is also made that life support procedures are those that are applied to only prolong the dying process due to a terminal illness or injury.

Making End-of-Life Decisions

1. Living Will

Information about the type of medical care you want to receive at the end of your life can be outlined in your living will. Living wills are only used if you cannot make your own medical decisions and you are in a medical condition that coincides with your state’s living will laws. It’s important to note that while living wills or advance directives are valid in all states, each state may have different laws governing them, and your living will may or may not be honored if you are in another state at the time of your death.

When creating your living will, it is important to determine what life-sustaining treatments you want to receive. Treatments can include dialysis, blood transfusions, cardiopulmonary resuscitation, respiration, surgery, nutrients such as food and water, and pain relief.

2. Establishing a Durable Power of Attorney or Health Care Proxy

To determine who will get to decide whether to end life support or what other treatment options should be used, you will need to establish a durable power of attorney (health care proxy). The durable power of attorney is the person you designate to follow your living will if you are not able to make those decisions for yourself.

The power given to the person you name as your durable power of attorney is generally broad and comprehensive, but it can be limited. (Talk to a lawyer if you have questions.) Common rights include:

  • Hiring and firing doctors
  • Visiting you in the hospital
  • Reviewing your medical records
  • Agreeing or refusing medical treatment for you
  • Determining what hospital to use
  • Legally challenging medical professionals who do not abide by your living will

(Note: Not all states use the term "durable power of attorney." Other common names include health care proxy, health care agent, health care power of attorney, durable power of attorney for health care and medical power of attorney.)

3. Do-Not-Resuscitate Order (DNR)

Another way that decisions about life support may be made is through a do-not-resuscitate (DNR) or do not intubate (DNI). A DNR or DNI can be written and included in your medical record without creating a living will. Many times, a DNR or DNI is used by critically ill patients who do not want to have life-sustaining procedures used if they are about to die.

It’s important to note that emergency service personnel will always attempt to resuscitate you unless you have a special out-of-hospital DNR form or bracelet used in your state.

Who gets to make decisions regarding switching off life support?

So, who gets to make decisions about whether or not to switch off life support? If you have created a durable power of attorney, whoever you have designated should be the person who makes the decision. What happens if you have not made this designation? The decision may be given to your spouse, adult children, a parent or a sibling.

There are times, however, when the process is not so clear-cut. In fact, there have been several instances when an attending physician has refused to honor a patient’s advance directive or living will. Laws determining what will happen if this occurs vary by state. For example, in the State of Texas, under Texas law (Texas Health and Safety Code 166.046), physicians may legally discontinue treatment they decide it is medically futile, even if it contradicts a patient’s advance directive. If this occurs, however, patients or their families have 10 days to find another health care provider and appeal the physician’s decision to a hospital ethics committee. Other states have similar laws.

Bottom Line

You may get to determine your own end-of-life care by planning ahead and creating a living will and appointing a durable power of attorney. If you have not taken these steps, the state may appoint someone to make these decisions for you. In other cases, however, it’s medical doctors or medical committees that end up making the decision whether to switch off life support.

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Whether you're facing a legal issue or just seeking information, Justipedia aims to be your most trusted resource for legal information on the Web. With the help of legal professionals across the country, we put the law in plain language to help answer your top legal questions.

Justipedia was founded by Internet veterans Cory Janssen and Mitchell Allen. Janssen founded Investopedia.com and grew it one of the largest investing sites on the Web. Allen is an author, speaker and the founder of LeadRival, the leading provider of pay-per-action advertising in consumer legal services.

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