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Previous Volume 353:2607-2612 December 15, 2005 Number 24 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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For two decades, clinicians have been guided by an agreement about the appropriate use of artificial nutrition and hydration (ANH). In general, ANH has been seen as a medical treatment that patients or their surrogates may accept or refuse on the basis of the same considerations that guide all other treatment decisions: the potential benefits, risks, and discomfort of the treatment and the religious and cultural beliefs of the patients or surrogates. Although this agreement has never been universal, it is well established among ethicists,¹ clinicians,^2,3,4,5 and the courts. For instance, the 1990 Supreme Court decision in the well-known case . . . [Full Text of this Article]

Clinical Decisions and Medical Evidence

Ethical Principles for Decision Making

Withholding or Withdrawal of Treatment

Evidence of Patient Preference

Lack of Advance Directive

Provision of Palliative Care

Obstacles to Ethical Decision Making

Conclusions

Source Information

From the Center for Health Equity Research and Promotion, Veterans Affairs Medical Center, Philadelphia (D.C.); and the Center for Bioethics and Institute on Aging (D.C., J.K., A.C.), the Division of Geriatric Medicine and Department of Medicine (D.C., J.K.), and the Leonard Davis Institute of Health Economics (D.C., A.C.), University of Pennsylvania, Philadelphia.

Related Letters:

Appropriate Use of Artificial Nutrition and Hydration
Cochrane T. I., Truog R. D., Mareiniss D. P., Glick S. M., Casarett D., Kapo J., Caplan A.
Extract | Full Text | PDF  
N Engl J Med 2006; 354:1320-1321, Mar 23, 2006. Correspondence

This article has been cited by other articles:

• Bryon, E, de Casterle, B D., Gastmans, C (2008). Nurses' attitudes towards artificial food or fluid administration in patients with dementia and in terminally ill patients: a review of the literature. J. Med. Ethics 34: 431-436 [Abstract] [Full Text]  
• Mitchell, S. L. (2007). A 93-Year-Old Man With Advanced Dementia and Eating Problems. JAMA 298: 2527-2536 [Abstract] [Full Text]  
• Hoffer, L J. (2006). Tube feeding in advanced dementia: the metabolic perspective. BMJ 333: 1214-1215 [Full Text]  
• Cochrane, T. I., Truog, R. D., Mareiniss, D. P., Glick, S. M., Casarett, D., Kapo, J., Caplan, A. (2006). Appropriate use of artificial nutrition and hydration.. NEJM 354: 1320-1321 [Full Text]