Factors related to adult patient decision making about withholding or withdrawing nutrition and/or hydration

(1) End-of-life decisions that focus on withholding or withdrawing nutritio n and/or hydration present difficult choices at particularly vulnerable tim es for patients and families. Clinical ethics studies published in the last twenty years provide insight about the decision making process that can be useful to all parties involved. The purpose of the systematic research rev iew is to synthesize empirical data about patient/surrogate decision making related to withholding or withdrawing nutritional sustenance toward the en d of life, and contextual factors that influence their decision making. Fut ure topics for clinical ethics research and clinical practice implications are posed.