Gastrointestinal Feeding Tube Laws

It is generally assumed that in the United States, a competent person has the right to refuse life-sustaining treatment, including the placement of a feeding tube. However, as of 2010 this has never been tested at the Supreme Court level. Some states have statutes on the books that refer specifically to tube feeding, but many do not. Other states choose to address the question of surrogacy in the cases of incompetent patients. These statutes state how surrogacy is determined for the purposes of assisting an incompetent person with end-of-life decisions.

Policy for Competent Persons

• According to Dr. David E. Milkes of Stanford University Medical Center, most United States appellate court decisions, the American Medical Association and one President's Commission agree that percutaneous endoscopic gastrostomy (PEG), though technically a form of force feeding, is a valid medical procedure. Furthermore, any competent patient has the right to refuse the placement of a gastrointestinal feeding tube.

Policy for Incompetent Persons

• No federal statute explicitly regulates the proper procedure for the administering and removal of gastrointestinal feeding tubes. However, cases concerning the tube feeding of incompetent persons have led to state-specific statutes regarding surrogacy in Missouri and New York. Missouri and New York give a competent person the general right to bodily integrity and the right to refuse treatment, including the power to remove a feeding tube. Policy for incompetent persons is not so simple. A surrogate, or person deigned legally eligible to make decisions for an incompetent person, must have "clear and convincing" evidence that proves the patient would want to end gastrointestinal tube feeding if she were competent enough to express that decision herself. Additionally, New York State's Family Health Care Decisions Act includes procedures for health care practitioners to determine if a patient has become legally incompetent. In the wake of the Terry Schiavo case in 2006, Governor Jeb Bush failed to convince the Florida legislature to pass a law making it illegal to remove a feeding tube from an incompetent person.

Advance Directives

• Most states have laws that allow a competent person to draft an advance directive. Advance directives detail a person's wishes with respect to future medical treatment and may include information about end-of-life decision-making. Advance directives may also authorize a particular person -- often, but not necessarily, a spouse or family member -- to make decisions for a patient should he become incompetent.