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AMA Policy on Provision of Life-Sustaining Medical Treatment

As stated by our Code of Medical Ethics, the American Medical Association believes that:

Patients have a right to participate in decisions about their medical care.  This fundamental principle of medical ethics holds true for all types of medical treatments.  Patients can refuse treatments even when such refusal is likely to result in death. 

Life-sustaining treatments should provide medical benefits and should respect a patient’s preferences, as communicated by the patient or a legally recognized surrogate.  Treatments such as mechanical ventilation and artificial nutrition and hydration should be provided only with appropriate authorization from a patient, a surrogate, or a court.  Once initiated, life sustaining treatments may be ethically withdrawn upon request of the patient, or a surrogate or court acting on the patient's behalf.

To assist patients and surrogates in the decision-making process, physicians have an obligation to provide medical expertise, competent diagnosis based on an appropriate evaluation of the patient, and therapeutic options that are in accord with accepted professional standards of care.

Advance directives provide an opportunity for patients to plan for future medical care in the event that they become unable to make decisions.  Advance directives allow patients to explore, discuss, and articulate preferences regarding medical care, including life-sustaining treatments.  Optimally, these preferences are written (for example, in a living will) and discussed with family or other loved ones, and with a physician.  Patients also can designate a trusted person to make health care decisions on their behalf if they are no longer able to make these decisions themselves.

When a patient cannot participate in the decision-making process and there is no advance directive, disputes may arise about what the patient would have preferred.  Occasionally, families and physicians cannot resolve these disputes.  As a last resort, disputes should be adjudicated by the courts, guided by what the patient would have wanted as best it can be determined.  The goal should always be to respect the rights and dignity of the patient.  Public officials, the media, family members, and all other parties also should respect the rights and dignity of the patient, including their right to privacy and to having their wishes respected.   

In light of recent increased attention to decision-making at the end of life, the AMA and its physician members are committed to intensified efforts to promote the use of advance directives, working with the U.S. Department of Health and Human Services, state medical associations, state bar associations, and others.