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Artificial nutrition and hydration at the end of life: Ethics and evidence

Published online by Cambridge University Press:  09 August 2006

LINDA GANZINI
LINDA GANZINI
Affiliation:
Departments of Psychiatry and Medicine, Oregon Health & Science University and the Mental Health Division, Portland Veterans Affairs Medical Center, Portland, Oregon
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Abstract

The case of Terri Schiavo resulted in substantial media attention about the use of artificial nutrition and hydration (ANH) especially by percutaneous endoscopic gastrostomy (PEG). In this article, I review ethical and legal principles governing decisions to choose or forgo ANH at the end of life, including issues of autonomy and decision-making capacity, similarities and differences between ANH and other medical treatments, the role of proxies when patients lack decision-making capacity, and the equivalence of withholding and withdrawing treatment. Evidence for palliative or life-sustaining benefits for ANH are reviewed in three disease processes: amyotrophic lateral sclerosis (ALS), cancer, and dementias, including Alzheimer's disease. Although more recent studies suggest a possible palliative role for ANH in ALS and terminal cancer, feeding tubes do not appear to prolong survival or increase comfort in advanced dementia of the Alzheimer's type.

Keywords

Palliative careAmyotrophic lateral sclerosisCancerAlzheimer's diseasePercutaneous endoscopic gastrostomy (PEG)
Type
Research Article
Information
Palliative & Supportive Care , Volume 4 , Issue 2 , June 2006 , pp. 135 - 143
Copyright
© 2006 Cambridge University Press

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