title: Artificial nutrition and hydration at the end of life: ethics and evidence.
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.
authors.affiliation: Department of Psychiatry and Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA. linda.ganzini@med.va.gov
authors.forename: Linda
authors.initials: L
authors.lastname: Ganzini
mesh_terms: D000544:Alzheimer Disease / Q000628:therapy; D000690:Amyotrophic Lateral Sclerosis / Q000628:therapy; D005774:Gastrostomy / Q000941:ethics*; D006801:Humans; D009369:Neoplasms / Q000628:therapy; D018529:Nutritional Support / Q000941:ethics*; D010166:Palliative Care / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics*