DISCONTINUATION OF TOTAL PARENTERAL-NUTRITION IN A PATIENT WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME - A CANADIAN PERSPECTIVE

Provision of nourishment to terminally ill patients has been a controv ersial topic in clinical medicine. Determination of the limits of pall iative care requires an understanding of the disease process, as well as the boundaries of patient self-determination. With the advent of li ving wills, the determination of the patient to limit care, including nutrition support, has become socially acceptable. Difficulties arise when there are differences of opinion between the caregiver and the pa tient The solutions to these conflicts are often decided in the courtr oom, as demonstrated by the Cruzan(1) and Quinlan(2) cases. Living wil ls are often written to prevent unnecessary financial burdens in hopel ess situations. As well, financial considerations influence the decisi ons made by caregivers in providing care to terminally ill patients. T he following case report illustrates the conflict between patient self -determination and limitation of care for financial reasons. The use o f substituted judgment within the Canadian health care system and the role of team meetings to resolve ethical decisions are discussed.