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SUMMARY
The ethics of dealing with the provision of nutrition has been greatly complicated by technological advances. Seventy percent of all deaths in the United States include a decision to forgo some life-sustaining treatment including nutrition support. This article reviews ethical issues in nutrition support, appropriate and inappropriate nutrition support, practical information regarding provision of nutrition, and the development of institutional policies regarding artificial nutrition and hydration. Communication is emphasized in the process of establishing an ethically defensible consensus between patient and caregiver regarding withholding or withdrawing nutrition support. Within this context, withholding and withdrawing this support are considered to have the same ethical significance. Artificial nutrition and hydration is considered medical therapy and can be refused by competent patients and surrogates of incompetent patients under certain circumstances. Patient autonomy is emphasized as a guiding ethical principle.
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Notes on contributors
Mark A. McCamish
Mark A. McCamish, PhD, MD, is Director of Clinical and Metabolic Research at Ross Laboratories, and Clinical Associate Professor of Medicine at Ohio State University in Columbus, OH.
Nancy J. Crocker
Nancy J. Crocker, MS, RD, is a nutrition support team dietitian at the University of California, Davis, Sacramento Medical Center, Sacramento, CA.