INTENSITY OF TREATMENT IN MALNUTRITION - THE ETHICAL CONSIDERATIONS

Physicians often face difficult decisions about initiating or terminat ing artificial feeding and hydration for seriously ill older patients. This article presents an approach to making these decisions, using ca se histories as illustrations. We discuss the distinctions between obl igatory basic care and optional medical care. We consider the process of weighing the burdens and benefits of treatment and the situations i n which it may be ethically permissible to withhold or withdraw artifi cial nutrition. Finally, we consider several cases in which the patien ts' previous statements of wishes are ambiguous, and suggest courses o f action for the physician in such situations.