Ethical issues in total parenteral nutrition.

Although a number of ethical issues have been identified with TPN use, the most pressing issues are equitable access to the technology; potential injustices toward other members of society because of the cost of the technology; quality of life issues, including prolongation of life; and decision making for TPN use. Empirical data on the factors that influence access to the technology and on the current utilization of TPN in elderly populations are needed to assess the issue of equitable access to the technology. In addition, the effects of the technology's cost on access need to be evaluated carefully. The decision-making process in the use of TPN and the relation of quality-of-life judgments to such decisions need further study and evaluation. In addition, factors that influence the decision to withdraw TPN also need to be identified and studied. Adequate ethical assessment of any technology relies in part, on empirical studies in the field, the sophistication of the ethical literature, and the careful delineation of the conceptual and methodologic issues associated with a particular technology's use. To the extent that these aspects can be addressed in the use of TPN, there is reason to believe that an adequate ethical assessment of the technology will be made, but such an assessment is not yet available.