For two decades, doctors have followed an ethically-established agreement about the appropriate use of artificial nutrition and hydration (ANH) for patients who are seriously ill or in a persistent vegetative state. Generally, patients or their surrogates have been able to accept or refuse ANH based upon considerations that guide most treatment decisions, i.e., potential benefits, risks, burden, religious and cultural beliefs. The Terri Schiavo case which included very open, dramatic disagreements among family members over such considerations publicly challenged long-held agreements about ANH and caused many to question its proper use.

In response to such challenges, researchers from the University of Pennsylvania's Institute on Aging and Center for Bioethics, and the Philadelphia VA's Center for Health Equity Research and Promotion review and clarify ethical principles regarding the use of ANH. According to the authors, the five ethical principles that should guide decisions about ANH are:

• Decisions about the use of ANH should be made in the same way that decisions about other medical treatment are made.
• The same ethical reasoning applies whether withholding or withdrawing ANH.
• Decisions on the patient's behalf require the same evidence of the patient's preferences as is required for other significant treatment decisions.
• Decisions about ANH may be made without any evidence of the patient's preferences.
• All Patients should receive high quality palliative care regardless of whether they receive ANH.

These recommendations are the result of a national conference held at the University of Pennsylvania in early 2005, and appear in the December 15th, 2005 issue of the New England Journal of Medicine.

"Re-examining the guiding principles of decisions to use ANH right now is essential." asserts David Casarett, MA, MD, Assistant Professor of Geriatrics, University of Pennsylvania School of Med
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Contact: Olivia Fermano
olivia.fermano@uphs.upenn.edu
215-349-5653
University of Pennsylvania School of Medicine
15-Dec-2005

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