Artifical Nutrition and Hydration (ANH) Conference
For many years clinicians have practiced within the bounds of a general 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 based on its potential benefits, risk, and burdens and their religious and cultural beliefs. While this position has never been universal, it has become well-established among ethicists, clinicians, and in the courts.However, this agreement has recently faced increasing challenges from several quarters. For instance, two recent court cases—those of Terri Schiavo and Robert Wendland—have cast doubt on the way that decisions about ANH should be made, and specifically on the ability of surrogates to make decisions on behalf of patients. Similarly, a recent Papal statement on this topic strongly discourages decisions to withdraw ANH from those in a Persistent Vegetative State (PVS). Finally, several states have made it more difficult to withdraw ANH than it is to withdraw other forms of life-sustaining treatment. These events have limited patients’ and families’ rights to make decisions about ANH and, more broadly, their right to make decisions about other forms of life-sustaining treatment.
In response to these events, the University of Pennsylvania’s Center for Bioethics convened a meeting of a diverse group of ethicists, clinicians, and legal and religious scholars. The goal of this meeting was to redefine and clarify a consensus about the appropriate use of ANH. The report of this meeting, written on behalf of the meeting participants and published in the New England Journal of Medicine, defines the current agreement about the appropriate use of ANH, and recommends steps that can promote clinical practice that is more consistent with this agreement.
David Casarett, M. D., Jennifer Kapo, M.D., and Arthur Caplan, Ph.D. (2005). "Appropriate Use of Artificial Nutrition and Hydration — Fundamental Principles and Recommendations." New England Journal of Medicine 353(24): 2606-2612.
