Opposing Viewpoints

There are disagreements about the use of artificial nutrition and hydration (Lipman). One viewpoint favors enteral feeding in most situations in which the ability to eat and drink has been lost. After all, it is a relatively simple and straightforward process, and while there is some risk involved in providing access, it is relatively small. Many would argue that doing so is, in fact, an obligation, that food and water are basic human needs under all circumstances. They do not view feeding tubes as medical or life-sustaining therapy. Moreover, there is the concern that because food and water are often viewed as a good, withholding or withdrawing them will cause suffering, akin to the traditionally held concepts of starvation.

On the other hand, an alternative and competing concept is based on the view that this traditional position just described, while at first glance justified by the clinical circumstances, is one for which factual support is lacking. Further, there is evidence that in some clinical settings, particularly terminal conditions, artificial nutrition and hydration may actually be harmful and may add to the burden of suffering that medical providers are trying to minimize. This viewpoint also holds that in the setting of illness, forced administration of nutrition and hydration, provided artificially via alternative access to the digestive system using specially designed equipment, represents medical treatment. As such, it contrasts with oral ingestion of food and water, which provide nurture and comfort.

In view of these contrasting perspectives, it becomes necessary to consider the variables that impact on a decision about the use of artificial nutrition and hydration.

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