[Should the obligation to feed continue until death? Viewpoint and conflict of the treating physician].
At first it is pointed out that artificial nutrition is an unphysiological measure. Its indication is part of the problem that we find it hard to accept the reality of death. In the course of his studies, a physician learns that it is his task to help and to heal. Preservation of life is seen as the equivalent of successful medicine. The conflict arises when palliative measures in an incurable illness may consist in the prolongation of life as well as in the shortening of suffering. The solution is easy, if the intent of the patient is known. If not, the physician has to act according to the presumed intent. In a terminally ill patient unable to express himself, artificial nutrition may be withheld, if the patient shows no signs of being hungry or thirsty and if there is general consent on the issue among physicians, family members and nursing staff. Truly difficult is the situation if we deal with a not terminally ill, yet permanently unconscious patient whose former views on the subject are not known. In such a case, the ultimate moral decision lies with the physician.
Oelz
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Medizinische Klinik Stadtspital Triemli, Zürich.
D001293:Attitude to Death; D006801:Humans; D016743:Mental Competency; D010166:Palliative Care; D010288:Parenteral Nutrition; D010344:Patient Advocacy; D010820:Physicians / Q000523:psychology; D013727:Terminal Care