Decisions at the End of Life

This chapter examines the similarities and differences between US and European legal thinking and jurisprudence regarding end-of-life medical care. In recent decades, courts and legislatures have increasingly respected the right to self-determination of patients or their families in deciding about the way people want to die. In most jurisdictions, patients may have unwanted medical treatment withheld or withdrawn, even when the treatment would be or is life-sustaining. Hospice and other palliative care are important alternatives, although in many cases, suffering may still persist. In a small but growing number of jurisdictions, patients may receive a lethal dose of medication to bring about death. Less recognized, but very important too, are cases in which patients request life-sustaining care that their health care providers consider “futile.” As with other rights, the right to make medical decisions is subject to limits. In deciding the extent of rights to make end-of-life decisions, the law has recognized that while seriously ill patients have the greatest stake in their medical care, family members, healthcare providers, and the state also have important interests. Accordingly, health law has had to balance a number of competing interests in determining when it is permissible to discontinue medical care or take other actions that will shorten life, and the scope of the right to decide has been much debated.