Withdrawal of ANH from PVS patients:
National Rapporteur Study
PORTUGAL
André Dias Pereira
http://wafml.memberlodge.org
http://www.centrodedireitobiomedico.org
http://www.uc.pt/fduc/corpo_docente/andreper
Question 1: When there is a clear and uncontested
diagnosis of ‘permanent vegetative state’ (sometimes termed ‘post-coma
unresponsiveness’), who has the legal authority to decide that artificial
nutrition and hydration should be withdrawn from the patient?
Answer: After an interview with the family
members and other close persons, the medical team, shall act according to the
presumed consent of the patients, that is, the medical team shall try to find
out what would have been the decision of the concrete patient, had she had the
opportunity to choose. See: Opinion on the Persistent Vegetative State – National
Council of Ethics for the Life Sciences – Opinion 45/2005; see also Art. 39
Penal Code and Art 340 (3) Civil Code, as well as Law 25/2012 (Art. 2 (2) (b)
(Advance Directives Act), which accepted the refusal of hydration and nutrition
in a living will.
Question 2: What decision-making criteria (if any) are
legally required in such situations?
Answer: The test that must be applied is
whether it is in accordance with the presumed wish of the patient to continue
ANH
Question 3: What decision-making processes (if any) are
legally required in such situations?
Answer: The medical team, listening to the
family, in making the decision, must consider the following factors (so far as
it’s possible):
1.
The patients’ past and present wishes and
feelings
2.
The patients’ beliefs and values that would be likely to influence his
decision if he had capacity
3.
Other factors that the patient would be likely to consider if he were
able to do so
The medical team must also first consult:
a)
Anyone previously named by the
patient as appropriate for consultation
b)
Anyone engaged in the patient’s
care or interested in his/her welfare
c)
Anyone to whom the patient
granted a lasting power of attorney
d)
Anyone whom the court has
previously appointed as a deputy for the patient
There is no required Court procedure or
authorisation.
The senior doctor, prior to withdrawing
ANH, must also obtain a declaration from the Court of Protection that it is
lawful to do so.
