At what point is a person removed from life support when no living will is present?
Without a living will, the removal of life support is typically a matter of medical judgment that the chance of a recovery is remote. There is no hard and fast rule or defining number of days for when such a determination is made.
In Pennsylvania, without a living will and healthcare power of attorney, the law allows a “close family member” to approve the removal of life support from a patient in a state of permanent unconsciousness without court approval and without a written advanced healthcare declaration, as long as at least two doctors qualified to evaluate the patient’s condition first certify in writing that the individual is in a permanent vegetative state. This is called the “substituted judgment rule.”
In a Pennsylvania Supreme Court case, In re Fiori, other family members disagreed with the decision to remove life support and challenged that decision in court. The court will applied “the best interest of the patient” standard, analyzing factors such as relief of suffering, no quality of life and no prospect of recovery, and allowed the substituted judgment of a close family membe. In the Fiori case, a “close family member” wasn't defined by the court and no guidance as to how to decide between conflicting view points of family members was provided. Therefore, these cases are presently determined on a case-by-case basis by the court.