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Ray
Ray, Lawyer
Category: Legal
Satisfied Customers: 29127
Experience:  29 years in civil, probate, real estate, elder law
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Feeding tube removal

Customer Question

My mother in law is currently in the hospital in poor condition due to multiple health issues. She is unable to swallow, but the problem may be treatable. However, that can't be determined unless the appropriate medication can be administered, which unfortunately is only available in pill form. Because of this, and the fact that she presently isn't getting adequate nutrition, we have to make a decision whether or not to allow the placement of a gastric feeding tube (a short-term nasal gastric tube is not being recommended because of the likelihood that she'll pull it out). Before we make this decision, we want to know what legal issues we might encounter if the medication fails to restore her ability to eat and we request to have the tube removed (in which case she'll be moved to hospice care). My husband has power of attorney over all medical decisions. We don't want my mother in law to be kept alive indefinitely via artificial means - if there's no quality of life or effective treatment to improve her condition. Will be able to have the tube removed, or will this become a legal matter down the road? The doctor advises us that this is something that is not infrequently done, but we're not clear on what may involved should anyone challenge our decision.

Submitted: 8 months ago.
Category: Legal
Expert:  Ray replied 8 months ago.

Ray :

Hello and welcome to Just Answer.Here you need to go over the Living Will and Health Care Power of Attorney and read the language of it.This is the standard language for Florida.

Ray :

Declaration made this _____ day of ________________, 2____, I, ____________________________,
willfully and voluntarily make known my desire that my dying not be artificially prolonged under the
circumstances set forth below, and I do hereby declare that, if at any time I am mentally or physically
incapacitated and
_____(initial) I have a terminal condition,
or _____(initial) I have an end-stage condition,
or _____(initial) I am in a persistent vegetative state,
and if my attending or treating physician and another consulting physician have determined that there is
no reasonable medical probability of my recovery from such condition, I direct that life-prolonging
procedures be withheld or withdrawn when the application of such procedures would serve only to
prolong artificially the process of dying, and that I be permitted to die naturally with only the
administration of medication or the performance of any

Ray :

This appears to require that the treating physician and the named person to agree here.

Ray :

I would have you ask some more questions about what the conditions would be in your case to then allow you to remove the tube.You want to know if the physician has input or it is yours alone.

Ray :

These are the standard ones.So it is critical to understand if this requires a joint agreement here or it is yours alone.

Ray :

The problem might be that once you allow this it is keeping her alive and she might not be in a vegetative state or terminally ill.

Ray :

I think you need some more answers here about whether this qualifies such that you alone can make the decision to remove.

Ray :

These are the definitions--ask doctor if she fits one of these today.

Ray :

A terminal condition, defined in Florida Statute 765.101 (17), is “a condition caused by injury, disease, or illness from which there is no reasonable medical probability of recovery and which, without treatment, can be expected to cause death.”

A persistent vegetative state, defined in Florida Statute 765.101 (12 a, b) is “a permanent and irreversible condition of unconsciousness in which there is: (a) the absence of voluntary action or cognitive behavior of any kind, (b) an inability to communicate or interact purposefully with the environment.”


An end-stage condition, defined in Florida Statute 765.101 (4), is “an irreversible condition that is caused by injury, disease, or illness which has resulted in progressively severe and permanent deterioration, and for which, to a reasonable degree of medical probability, treatment of the irreversible condition would be ineffective.”

Ray :

These are the kinds of questions you need to ask before you agree here.You want to know exactly whether she has this type of condition such that the tube can be removed.

Ray :

And that it would be your decision alone.

Customer:

I have all of the forms - and have researched tube removal. Most directives address whether or not an individual wants extraordinary measures instigated, but say little or nothing about removing existing artificial support. The doctor says he doesn't anticipate a problem - that this is periodically done, but then he wavers when we try to confirm. And even if a particular doctor agrees in advance, he/she may not be in the picture when/if the decision has to be made. All roads point to this being a legal issue, not one for the doctors.

Ray :

I think that you have a valid concern here.I don't think that she qualifies under the definitions from what you present so removing it here may be a real problem.I would not agree until you are given the answers you want to hear.Otherwise once it is in here it may be real hard to remove unless her condition changes over time.

Customer:

We do know that without the tube, she will not survive. At least one of her doctors is not optimistic that she will get much better, even with treatment. We feel strongly that a tube would only be appropriate if there's some chance that she will be able to begin eating on her own at some point.

Ray :

It is a truly tough situation.I would tell you to think long and hard here because vagueness usually means that you alone could not remove it later on unless her condition changes.

Ray :

I wish I could tell you otherwise.

Ray :

I mean its a no brainer if she is terminally ill or a persistent vegatative state but here it sounds like she would not qualify--so you may ask more questions and you may decide here not to do it.At some point you do what you think the person would want and nobody can second guess your call.

Ray :

I am so sorry that you are having to go through all of this.I can only imagine the difficulty here.

Customer:

That's the problem. We can't fully assess her condition unless they're able to get the drug into her. Since she can't swallow, the only way option is a tube. If the drug fails to restore swallowing function, then what? We can't subject her that kind of existence. She doesn't have dementia, but she's not really able to understand the consequences of either choice. How do we find out what the legal reality is in Florida? Should I re-post my question and request a Florida attorney, or is this not a regional issue?

Ray :

This was a famous case that lead to some changes here in Florida I am sure you remember it.

Ray :

The law here only allows for the removal in situations that meet the definitions above of the Florida statute.

Ray :

If she is not terminal or in persistent vegetative state here then the law does not necessarily allow you to remove it.The physician would have to concur.

Ray :

That's why I think you are getting vague answers from the doctors.

Ray :

If you allow them to put it in it may be hard to get them to agree to remove it later on.

Ray :

The statute above controls the decision making process in Florida.

Customer:

Of course, I recall the Schiavo case. In fact, the doctor mentioned it, which upset us, since we thought he was advising us that we could have the tube removed if her ability to eat was not restored. If the doctor agrees that the tube is being placed only to determine if her condition is reversible - and charts (or signs something) to that affect, would that be sufficient?

Ray :

Yes just make sure you get the answers you are seeking about removing it.

Ray :

It may be that the doctor would agree that her condition falls under the law and can be removed.But you want to be sure here that it does and something is written in the chart or otherwise noted for your protection.

Customer:

Yes, you think the doctor agreeing in some written form before the tube is placed would be sufficient?

Ray :

Yes I do and it is reasonable for you to ask for that assurance.

Ray :

And I certainly will say a little prayer for you that the medication works for her.I wish you and her the best.

Ray :

And if it makes you feel better here I had to do this with my own father.Its a tough call no doubt.

Customer:

Thank you. There is no obvious right answer here. If we don't try to restore function, we may always wonder if we deprived her of a chance to get better. If she doesn't improve, then we may have tethered her to a tube. with no quality of life. Even if she had a medical directive in place, I don't know that it would address this unique situation.

Ray :

I agree it is unique and I wish you the best.These kinds of things are just some of the hardest things you will ever do.

Ray :

If you can leave a positive rating it is much appreciated.Thanks again.

Ray, Lawyer
Category: Legal
Satisfied Customers: 29127
Experience: 29 years in civil, probate, real estate, elder law
Ray and 5 other Legal Specialists are ready to help you
Expert:  Ray replied 8 months ago.
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Expert:  Ray replied 8 months ago.
Thank you for your positive rating of my service to you. Let me know if you need more help or have future questions. I will be here for you. Just ask for me by name at the start of your question - "Ray" .


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