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"We must have clear, compelling and written evidence that that is the patient's desire before that is removed," Stevens argued, adding that allowing such decisions to be made based on hearsay testimony creates the potential for conflicts of interest, especially when those testifying stand to gain financially from the death of the disabled individual.

Even when such a written directive not to use a feeding tube to keep a patient alive exists, Stevens argued that the physician's ethical responsibility continues.

"The critical issue is that, if you do not put a feeding tube in, you must, you must offer food and water by mouth," Stevens said. "If you don't do that, it's not the disease that kills the patient. It's you that kills the patient.

"That was the big ethical issue, the most foundational issue in the Terri Schiavo case," Stevens said. "That is like not only taking someone off a respirator because it's futile, but also, at the same time, removing all of the oxygen from the room.

"Your intent is not to remove a burdensome therapy," Stevens concluded. "Your intent is to remove a burdensome patient."

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