End-of-life care: What do the American courts say?

End-of-life care of critically ill patients generally consists of two close ly related practices: the withholding and withdrawal of life support, and t he administration of palliative care. In the United States, the withholding or withdrawal of life support is legally justified by the principles of in formed consent and informed refusal. The U.S. Supreme Court has held that c ompetent patients may refuse any and all treatments, including those that s ustain life. All states sanction such refusal by competent patients, and mo st states allow surrogates to refuse treatment on behalf of incompetent pat ients. Although some physicians use the concept of futility to unilaterally withhold or withdraw life support, the Supreme Court has not heard a futil ity case, and the only clear legal rule on futile treatment is the traditio nal malpractice test, which measures physician actions against standards of medical care. However, the Supreme Court has furnished guidelines on the a dministration of palliative care. By using the principle of double effect, these guidelines allow physicians to give sedative and analgesic agents to dying patients if they intend to relive pain and suffering but not to haste n death.