Description

Improvements in medical technology over the last 25 years mean that it is now virtually always possible to provide artificial nutrition and hydration (ANH) to patients in a wide variety of clinical scenarios. This raises an ethical question: just because we can feed patients artificially, should we? Put another way, when is it right to withhold or withdraw this particular life sustaining treatment from a given patient?

Deciding which patients will benefit from the provision of ANH is difficult, particularly following stroke or the onset of dementia. Where patients lack capacity to make their own decisions, health professionals are under an obligation to act in the patients best interests. Lack of robust scientific evidence for benefit, disagreement about which interests should be considered and wide variance in the values held by all concerned render such decisions fraught and vulnerable to challenge.

In deciding how to proceed it is necessary to consider three things. Firstly one must review the clinical evidence base for ANH. This is of particular importance when there is genuine clinical uncertainty. Secondly a clinician must be aware of the legal principles applying to a clinical decision to either withhold or withdraw life sustaining treatment. Thirdly, and perhaps most difficult it is necessary to address the ethical dilemmas raised by such decisions.