Against the emerging stream. Should fluids and nutritional support be discontinued?

The powerful rhetoric of "death with dignity" has gained intellectual currency and practical importance in recent years. Initially, this rhetoric was a plea for more humane and individualized treatment in the face of the sometimes cold and impersonal technologic imperatives of modern medicine. As such, it brought needed attention to the plight of dying patients and prompted legal and clinical changes that empowered such patients (and, at times, their representatives) to assert some control over the manner, if not the fact, of their dying. The death with dignity movement has advanced to a new frontier: the termination or withdrawal of fluids and nutritional support. As recently as five years ago, or perhaps three, the idea that fluids and nutriment might be withdrawn, with moral and perhaps legal impunity, from dying patients, was a notion that would have been repudiated, if not condemned, by most health professionals. They would have regarded