The Ethics of Medically Assisted Nutrition and Hydration at the End of Life

This chapter examines the ethics of medically supplying nutrition and hydration to dying patients. It first considers the available treatment modalities for patients who are unable to eat or drink, including nasogastric tube feeding, percutaneous endoscopic gastrostomy tube feeding, surgical gastrostomy or jejunostomy tube feeding, proctoclysis, intravenous hydration and nutrition, total or partial parenteral nutrition, and hypodermoclysis. Before discussing the ethics of their use in palliative medicine, the medical aspects of these techniques as well as their risks and benefits are outlined. The author then proposes a classification of four critical decisional junctures along the trajectory of disease progression and highlights a number of disabling, chronic, progressive, and eventually fatal diagnoses with differing trajectories toward death. Finally, it looks at a number of ethical controversies surrounding medically assisted nutrition and hydration, including the issue of religion and the moral and psychological aspects of stopping and starting nutritional therapy.