Decisions about artificial feeding arouse more controversy than those involving any other life-sustaining treatment. Because food and water are generally considered basic elements of humane care, representing love and concern for the helpless, it is often thought that they must always be provided. In a landmark decision, the Supreme Judicial Court of Massachusetts ruled that a feeding tube could be removed from a patient in a persistent vegetative state if this was consistent with his previously expressed wishes. The case of Paul E. Brophy, Sr., is part of an emerging medical and legal consensus on the withholding of artificial feeding from adult patients. The view is growing that tube and intravenous feeding should be likened to other medical interventions and not to the routine provision of nursing care or comfort. Competent patients have the right to refuse such feeding. Feeding can also be stopped incompetent patients who have earlier stated such a wish.
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Division of General Internal Medicine, University of California, San Francisco.
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