Abstract Rationale This review examines the law and legal precedents on withdrawal of life-sustaining therapies in patients without decision making capacity in Puerto Rico (PR). Our aim is to improve understanding of Puerto Rico’s law on surrogate decision making within the medical community and ensure adequate end of life care of incapacitated patients. Methods consisted of literature review. A law scholar was consulted for proper law interpretation. The main legal precedents examined are Law 160- 2001 and the “Lozada case”. Results In an attempt to streamline advance guidelines in patient care, the Puerto Rico Legislature enacted Law 160-2001, titled “Terminal Health Condition or Advanced Statement of Will Regarding Treatment” This law states that any competent person of 21 years of age or older may set advance directives to be followed in the case of incapacity or a terminal health condition. These advance directives include a living will and/or healthcare proxy. Per this law (article 3), proxies cannot limit life sustaining therapies unless the patient is actively dying. This went under scrutiny when Mr. Victor Hernández Laboy, a Jehovah’s witness with advance directives rejecting blood transfusions, was left unconscious due to TBI. This case argued that Article 3 of Law 160-2001 is unconstitutional and established that an individual has the constitutional right to refuse medical treatment by virtue of their religious beliefs regardless of their prognosis. However, the law was not amended after such case and continues to generate conflict within the medical community. Conclusions We found that there is no legal mechanism in PR to withhold or withdraw life-sustaining treatment unless the patient specifically expressed it in a living will pursuant to law. This does not mean it is illegal to do so in other instances, it merely means that the current law did not envision this. Article 3 of Law 160-2001 limits withdrawal by proxy by offering a vague concept on end-of-life care and denying withdrawal of life sustaining therapies unless in the event of active phase of death. By leaving room for interpretation, this law fails to clearly establish the requirement to respect the patient’s decision via advance directive or surrogate.The failure to amend the law after the Lozada case creates confusion among physicians who may not be aware of said article’s unconstitutionality and updated legality of practice. Because of this, it is common for hospitals to rule out withholding and withdrawal based on misinformation, regardless of proxy deliverance. This abstract is funded by: Alan-Gleitsman Student research fund
Diaz et al. (Fri,) studied this question.