From means to ends: artificial nutrition and hydration.

The withdrawal, withholding, or implementation of life-sustaining treatments such as artificial nutrition and hydration challenge nurses on a daily basis. To meet these challenges, nurses need the composite skills of moral and ethical discernment, practical wisdom and a knowledge base that justifies reasoning and actions that support patient and family decision making. Nurses' moral knowledge develops through experiential learning, didactic learning, and deliberation of ethical principles that merge with moral intuition, ethical codes, and moral theories. Only when a nurse becomes skilled and confident in gathering empiric and ethical knowledge can he or she fully act as a moral agent in assisting families faced with making highly emotional decisions regarding the provision, withholding, or withdrawal of artificial nutrition and hydration.