Summary and Conclusion

The symbolism associated with eating a meal, and wanting to provide nutrition when this is not possible, involves concepts that have been deeply ingrained in society for centuries. They traverse cultural boundaries. Technology affords society a relatively easy means of artificially providing food and fluids when oral intake diminishes or ceases. Thus, placing a feeding tube relieves the provider of liability concerns for not treating, and family or surrogates are relived of guilt for not feeding. Yet a tension exists. The idea of a seemingly simple way to provide food when a patient is not eating conflicts with the more ominous themes in the clinical settings considered herein of failing to benefit, adding to suffering, and using technology that may be dehumanizing and disrespectful.

Howard Brody has suggested that artificial nutrition and hydration in terminal illness may be ".. .a textbook case of disproportionate care, which patients may choose to forgo" (p. 740). A principlist analysis would likewise argue that both beneficence and autonomy might be in jeopardy if artificial nutrition and hydration are initiated in patients with terminal illness. Lastly, while the definition of medical futility is debatable, a physician is not obligated to provide treatment so judged; while sometimes considered an affront to autonomy, an element of paternalism may contribute to effective medical decision making, although physicians may hesitate to exercise it.

In many patients with advanced dementia, terminal cancer, and neurological devastation, artificial feeding is inappropriate. The ethical and legal basis for withholding this treatment discussed earlier is sound. While a morally pluralistic society will always generate different views because of competing value systems, the differences may not be as great as they might seem. While respecting these views, the goal of ethically sound decision making can realistically be achieved in most cases in a manner satisfactory to all.

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