In most U.S. jurisdictions the legal right of a clinician to refuse a patient/surrogate request for life-sustaining treatment can be represented by the following categorical syllogism:
Major premise: Healthcare providers may (without sanction) unilaterally refuse to initiate or continue requested interventions outside the standard of care.
Minor premise: Intervention x is outside the standard of care.
Conclusion: Therefore, the provider may withhold or withdraw x, even without patient or surrogate consent.
Both the law and the logic of this syllogism are "valid." But it is unclear whether they are "sound." U.S. providers have a really tough time establishing the truth of the minor premise with respect to any given x. Consequently, the statutory "permission" granted in most states (i.e. the major premise) ends up being illusory. The boundaries of the safe harbor are just too fuzzy to give the requisite legal certainty and comfort.
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