The decision to withdraw tube feeding.

Physicians involved in the care of elderly patients are often faced with end-of-life decisions including withholding or withdrawal of tube feeding. More than 80% of deaths take place in the hospital or nursing home and the prolongation of life by medical technology has replaced natural processes. We believe the availability of life-sustaining medical technology including tube feeding does not make physicians ethically obligated to use it once it is known that health and function cannot be restored and the burdens outweight the benefits. Patients and their surrogate decision-makers have a right to refuse life-sustaining medical treatment they find burdensome. Tube feeding as a medical treatment, witholding of tube feeding as equivalent to withdrawal of tube feeding, the benefits versus the burdens of tube feeding, and the decision-making process involved in the withdrawal of medical treatment are considered Hawaii's statutes as they apply to decision-making and examples of cases to illustrate how these concepts are pertinent to patients whom we encounter in clinical practice are discussed.