After you have decided whether and when to remove life support when setting up a Living Will (a.k.a. the Advance Directive, End of Life Directive), the next question is whether and when do you want to have artificial nutrition and hydration removed?  Most people, wrongly, assume artificial nutrition and/or hydration are considered part of life support and, therefore, would be removed at the same time as life support.  However, the question of whether and when to remove artificial nutrition and hydration is a separate, but critical, question to be answered as part of setting up a Living Will. 

You may recall the situation of Terri Schiavo from Florida.  After suffering a cardiac arrest and being resuscitated, she was determined to be in a “Persistent Vegetative State”, and she had a living will directing the removal of life support.  However, her doctors and her parents did not believe the Florida definition of life support included the removal of artificial nutrition and hydration.  Thus, her husband spent the next 7 years in a legal battle, including a presidential intervention, governor intervention and multiple court decisions, to finally obtain legal authority to remove artificial nutrition and hydration.  As a result, we now ask the questions about removal of life support and removal of artificial nutrition and hydration separately. 

The first thing to understand about this question and the options for removal is that artificial nutrition and hydration are going to be provided if you are on life support and for as long as you are on life support.  However, once life support is removed, artificial nutrition and hydration are optional.  Thus, your options are to remove artificial nutrition at the same time as life support, continue it for a period of time after life support or continue it, basically, indefinitely. 

For most people, the removal of artificial nutrition and hydration is simply a part of removing life support, and they want it removed at the same time so as not to unnecessarily prolong the inevitable/intended result of removing life support, which is death.  Less commonly, other people want artificial nutrition and hydration to be continued for a period of time after removing life support, and even less commonly, some people want to have artificial nutrition and hydration continued indefinitely. 

Again, there is no right or wrong choice here either.  The most important thing is understanding your choices and choosing what makes the most sense and is best for you and your family.