Rules on refusing nutrition draw suit in Arkansas
An association of Arkansas’ long-term care facilities says the state’s Department of Human Services is misinterpreting state law by prohibiting nursing homes from honoring requests to withhold nutrition and hydration from residents unless certain criteria are met.
The Arkansas Health Care Association filed suit in Pulaski County Circuit Court naming as defendants Kurt Knickrehm, director of the state Department of Human Services, the department, and its Office of Long Term Care. At issue is a Jan. 23, 2001, declaratory order from the department that allows nursing homes to withhold nutrition and hydration for a resident only if:
- the resident has signed an advance directive or health care proxy as provided for under the Arkansas Rights of the Terminally Ill or Permanently Unconscious Act;
- the resident specifically includes nutrition and hydration as life-sustaining treatments the resident wishes to have withdrawn.
The association argues that the finding that nutrition and hydration must be specifically mentioned is erroneous. Little Rock attorney Elizabeth Andreoli contends in the filing that the department’s ruling on nutrition and hydration isn’t in line with other Arkansas statutes or with constitutional or common law. The lawsuit says the department is ignoring parts of the Arkansas Rights of the Terminally Ill or Permanently Unconscious Act. She also says the department is adding a requirement to the act that does not exist.
"The Act does not include a requirement that the advance directive or health care proxy contain an express reference to nutrition and hydration," the lawsuit says.
The suit says nursing homes, which may be found in noncompliance with department regulations if they violate the rule, are often asked by patients, family members, or legal representatives of an incapacitated patient to withhold life-sustaining treatment, including nutrition and hydration.
Andreoli says the rule places nursing homes and their employees at risk for violating state and federal laws and their own professional standards by providing unwanted treatment. Department of Human Services officials maintain their position is consistent with a 1990 U.S. Supreme Court ruling in the case of Cruzan v. Missouri Department of Health.
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