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November 1985

Ethics, Law, and Nutritional Support-Reply

Arch Intern Med. 1985;145(11):2131. doi:10.1001/archinte.1985.00360110207051

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—We thank Mr Landsman for his comments on the family's power to authorize nontreatment of their incompetent adult relatives. The Virginia statute does permit specified family members to authorize termination of life-prolonging treatment of incompetent adult relatives whose deaths are imminent. We would also like to note that the Texas legislature recently enacted a similar provision, which became effective Sept 1, 1985. The Maryland statute, however, allows relatives to give substituted consent for furnishing medical treatment to incompetent adult patients. This law fails to confer on family members explicit authority to refuse life-sustaining treatment on behalf of an incompetent adult relative.

Although none of the court decisions Mr Landsman cites required judicial approval of nontreatment decisions, Conroy and Colyer required that decisions to terminate life-sustaining treatment be made by the incompetent patient's legal guardian. The Storar case failed to address the question of whether a legal guardian must authorize nontreatment.

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