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  • Want to follow patient's best interests, not the self-serving family
  • Sometimes hard because the patient might be vegetative
  • E.g. someone in vegetative state, husband wanted her to die, family wanted her to live.
    • She can breathe, has heartbeat etc. She just has a nasogastric tube for food.
  • American pro-life extremists offer husband heaps of money; people try to make it illegal to remove NGT
  • 1) Who decides what is in the patient's best interests? Doctors may disagree, etc etc
  • 2) Is NGT a medical procedure or is it a social/compassion thing?
  • Another case: EEG shows someone has no cortical function.
  • Treatment can be withdrawn by supreme court irrespective of family's objections.
  • Important: futility of treatment - weigh up burdens and benefits of treatments
    • Many argue it's not in best interests to be vegetative
  • Courts tend to support clinical judgement
  • Different US states have various different rules about when you can let someone die
  • Advanced care directives
  • You have to be in a vegetative state for 6 months for it to be considered chronic
    • Judges have said you need to continue treatment until after 6 months
  • Advanced care directives can help keep cases outside the courts.
  • Be aware of prognoses, that may change with time as new medical knowledge appears.
  • Families can go against advance care directives unless all the medical weight supports treatment