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Paper Presentation

Clinical Ethics

Session: Clinical Ethics: Life Sustaining Treatment

US State Statutes Addressing Unilateral Clinician Decisions About Life-sustaining Treatment

Friday, October 24, 2025
8:00 AM - 9:00 AM Pacific Time
Location: B113-114
Michael Huber – University of Miami; Leigh Meyer – Mayo Clinic; Patrick Lyons – Oregon Health Sciences University; William Parker – University of Chicago; Erin DeMartino – Mayo Clinic
Abstract:

Introduction: Unilateral clinician decisions to decline initiating or maintaining life-sustaining treatment (LST) are controversial and are used disproportionately for vulnerable populations. US hospital policies addressing these decisions rarely acknowledge these concerns. Little is known about how US state statutes guide unilateral clinician decisions to decline initiating or maintaining LST.

Methods: Statutes addressing decisions to withhold or withdraw LST were identified by two independent reviewers between September 2024 and March 2025 for all US states and Washington, DC, using Fastcase, Casetext, and state government websites. Reviewers identified which US state statutes support unilateral clinician decisions to decline initiating or maintaining LST.

Results: Almost all statutes (98%, n=50/51) explicitly supported unilateral clinician decisions to decline initiating or maintaining at least one form of LST. Reasons supporting these decisions varied including medical reasons only (20%, n=10/51), reasons of conscience only (18%, n=9/51), both medical reasons and reasons of conscience (39%, n=20/51), or no medical or conscience reason explicitly provided (24%, n=12/51). For statutes including one or more medical reasons to support unilateral clinician decisions, specific reasons provided included if LST was “medically ineffective” (37%, n=11/30), “contrary to medical standards” (30%, n=9/30), “medically inappropriate” (27%, n=8/30), “nonbeneficial” (13%, n=4/30), and/or “medically futile” (10%, n=3/30).

Discussion: While almost all US state statutes allow clinicians to decline initiating or maintaining LST in at least some situations, the reasons supporting and actions required to pursue these decisions varied widely. This may contribute to established differences in the provision of LST across the US.

Keywords: unilateral do-not-resuscitate, end-of-life care

Learning Objectives:

After participating in this conference, attendees should be able to:
  • Explain which US state statutes support unilateral clinician decisions to decline initiating or maintaining life-sustaining treatment.
  • Explore the criteria required to pursue unilateral clinician decisions to decline initiating or maintaining life-sustaining treatment across states.
  • Understand how differences in state statute support for unilateral clinician decisions may contribute to established differences in the provision of life-sustaining treatment across the United States.