Tube feeding dilemmas: can artificial nutrition and hydration be legally or ethically withheld or withdrawn?

The incidence of elderly patients receiving long-term artificial nutrition and hydration via a percutaneous endoscopic gastrostomy (PEG) feeding tube is increasing. The wisdom of this practice is debatable when poor quality of life is often the outcome, and this has resulted in a dichotomy of opinions. The legal and ethical implications of withholding or withdrawing life-sustaining nourishment, however, appear to be formidable. This paper examines the judicial trends and the ethical reasoning which influence health care professionals, and attempts to answer the question "can artificial hydration and nutrition be legally or ethically withheld or withdrawn?' The value of advance directives and surrogate decision-making for non autonomous patients is considered, and the quality of life concept is discussed. A bias towards the reductionist male ethos may exist and may be influencing the developing case law. It is recommended that the nursing profession helps to redress the imbalance by becoming more active in ethical decision-making.