When patients resist feeding. Medical, ethical, and legal considerations.

In the recent past, public and professional attention has focused on the question of whether and when it is appropriate to discontinue nutritional support from patients unable or unwilling to ingest food orally. This article addresses the special problems raised by patients who resist medical feeding. It discusses the following issues relevant to this patient group: competency to make treatment choices, decision making on behalf of incompetent patients, the competent patient's right of self-determination, and procedures for reviewing treatment decisions. Legal decisions bearing on the nourishment question are analyzed as well. Although the author concludes that cessation of nourishment is morally and legally permissible in a few cases, she also cautions that the option should be carefully and narrowly applied.