You asked us to contact some Connecticut hospitals to determine their policies with respect to honoring living wills, including directives on withholding or withdrawing of nutrition and hydration. When possible, you asked us to get the hospital’s written policies.

We requested policies on living wills from nine hospitals: Hartford Hospital, Hospital of St. Raphael, New Britain General Hospital, St. Francis Hospital and Medical Center, St. Mary’s Hospital, St. Vincent’s Medical Center, Yale-New Haven Hospital, Waterbury Hospital, Manchester Memorial Hospital, and Rockville General Hospital.

Seven of these hospitals (Waterbury, Manchester Memorial, Hartford, New Britain General, St. Mary’s, St. Francis, and Yale New Haven) provided us with at least a portion of their policies regarding living wills and the withdrawal of nutrition and hydration. The other two provided verbal information.

Each of the nine hospitals indicated that it honors the wishes patients express in their living wills. This includes honoring a directive to withdraw or withhold artificially provided nutrition and hydration when in a terminal condition or permanently unconscious. If a living will does

not exist, end of life decisions pass to a health care agent designated by law or the next of kin. They also indicated that their ethics committees handle any dispute between requests by the patient indicated in the living will and those of the health care agent or next of kin when the patient lacks decision-making capacity.

Every hospital must also adhere to the Federal Patient Self-Determination Act (PSDA) of 1990. This act requires Medicare and Medicaid providers (hospitals, nursing homes, hospice programs, home health agencies, and HMO’s) to give adult individuals, at the time of inpatient admission or enrollment, certain information about their rights under state advance directives laws, including: (1) the right to participate in and direct their own health care decisions, (2) the right to accept or refuse medical or surgical treatment, (3) the right to prepare an advance directive, and (4) information on the provider’s policies that govern the utilization of these rights. The act also prohibits institutions from discriminating against a patient who does not have an advance directive. The PSDA further requires institutions to document patient information and provide ongoing community education on advance directives (42 § 1395 cc).

In addition to federal and state law, Catholic hospitals also may consider directives issued by the United States Conference of Catholic Bishops. For example, St. Mary’s Code of Ethical Behavior states, “as a Catholic institution we adhere to the Ethical and Religious Directives of Catholic Health Care Services (4^th edition) and the teaching of the Roman Catholic Church. ” Directives 56 to 58 provide guidelines on preserving human life through medically assisted nutrition and hydration. Directive 58 explicitly states, “[t]here should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient. ”

We have enclosed a copy of a recent OLR report, (2005-R-0455), which summarizes Connecticut’s living will law and copies of the hospital’s policies on living wills and nutrition and hydration. Hartford and St. Francis hospitals did not give permission for policy disclosure.

EP: ts