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Ethical Controversies

Can Food and Water Be Denied

CAN FOOD AND WATER BE DENIED?

This scenario was adapted from The Nurse's Dilemma by B. L. Tate. (Geneva, Switzerland: International Council of Nurses, 1977)

Position One: Feed Her

You are an employee of a rehabilitation hospital. One of the patients in your care is a 24-year-old woman, Ann, who was the victim of an automobile accident two years ago. Ann did not regain consciousness after the accident and for the past two years your hospital has been providing food and water to her through a tube.

Ann's family has visited every week since her admission to your hospital. During the last visit they again asked if there was any possibility of Ann regaining consciousness. It is your opinion and the opinion of the rest of the medical staff that recovery is extremely unlikely. As a result of that report, Ann's family has requested that food and water be discontinued, which will, of course, result in death.

What do you do?

Medical practitioners are responsible for making decisions about medical treatment issues. Giving food and water is not medical treatment. Access to food and water is a primary right of human beings, whether or not they are helpless. Therefore, food and water should continue to be provided for Ann.

Removing food and water is not just allowing someone to die. The goal of removing food and water would be to make sure Ann died, just like killing her. It would be no different from administering a lethal injection.

Even if giving food and water were a medical treatment there is no reason to withhold them. It cannot be argued that it is a useless treatment or that it is a burden, since Ann needs them to live.

It also cannot be argued that because she is unconscious Ann is just a body and not a person. The fact that we cannot cure her does not mean we cannot care for her. If she were just a body, the logical conclusion would be to get rid of her; few people would accept this argument. Removing food and water is equivalent to getting rid of a body.

Position Two: Withhold Treatment

You are an employee of a rehabilitation hospital. One of the patients in your care is a 24-year-old woman, Ann, who was the victim of an automobile accident two years ago. Ann did not regain consciousness after the accident and for the past two years your hospital has been providing food and water to her through a tube.

Ann's family has visited every week since her admission to your hospital. During the last visit they again asked if there was any possibility of Ann regaining consciousness. It is your opinion and the opinion of the rest of the medical staff that recovery is extremely unlikely. As a result of that report, Ann's family has requested that food and water be discontinued, which will, of course, result in death.

What do you do?

Administering food and water is a medical treatment rather than ordinary care in the case of unconscious patients because a feeding tube must be inserted either through the esophagus or the abdominal wall. This procedure often necessitates restraining the patient, and it involves risks. Therefore, just like any other medical treatment, it should be discontinued in some cases.

While circumstances that justify withholding food and water are rare, in some cases it is legitimate to do so. Food and water should be withheld when "the improvement in nutritional and fluid balance, though achievable, could be of no benefit to the patient" or when "the burdens of receiving the treatment may outweigh the benefit.” In some cases nutrition is of no benefit and the risks associated with giving nutrition make it a burden,

Just a hundred years ago it was not feasible to administer food and water in this way. Undoubtedly many people died of a lack of food and water in what was then considered a natural process. In some cases, such as Ann's, it should still be considered a natural process.