From ethical dilemma to hospital policy. The withholding or withdrawing of artificially provided nutrition and hydration.

In 1990 St. Joseph's Hospital and Medical Center, Paterson, NJ, established a committee to create an institutional policy to facilitate the decision-making process when patients or their legally authorized surrogates request the withholding or withdrawing of artificially provided nutrition and hydration. Before drafting a policy, the committee agreed on the philosophical, ethical, and medical assumptions that would be the foundation for the policy. The group adopted nine policy assumptions and provided guidelines that address concerns common to all healthcare facilities. No policy that addresses the issue of when to withhold or withdraw life-sustaining treatment will be perfect, nor will it resolve all the complexities of such a decision. However, an imperfect policy is preferable to the absence of a policy, which can lead to an abuse of patients' rights and contribute to arbitrariness in medical decision making.