These directives apply whether the patient is fed orally or through a tube.
- While inserting a feeding tube may require surgery or other medical expertise, food and fluids themselves are not medical treatment because they do not cure, they sustain life.
- Removing food and fluids from those able to eat and drink on their own or with the assistance of another person is never appropriate.
- Tube-feeding persistently non-responsive patients is obligatory in most cases since it is beneficial and usually does not add a serious burden.
- For terminally ill patients, the provision of food and fluids is generally obligatory care.
- When death is so close that further nutrition and hydration will no longer sustain life, they may be discontinued if the patient is more comfortable without them.
It is most important to examine intent. If the intention is to hasten or cause death, the omission of food and fluids is wrong.
[Lifeline readers have asked about practical guidelines for making moral decisions regarding the provision or withdrawal of food and fluids. The following list was originally published as a sidebar in an article by Julie A. Grimstad in LIFESCENES (Spring 2003). LIFESCENES is published by CA Nurses for Ethical Standards, 4521 N. Sultana Ave., Rosemead, CA, 91770. Julie A. Grimstad has been Director of the Center for the Rights of the Terminally Ill since 1987.—Ed.]