Withholding Nutrition Ethics Statement
The primary goal of the Christian clinical ethic is to provide compassionate medical care to all human beings. We recognize that nutritional support is both a universal human biologic requirement and a fundamental demonstration of human caring. Because we believe there should be a basic covenant between all of us to care for those who are incapacitated, we are committed to the provision of food and water to those who cannot feed themselves.
In exceptional cases, tube feeding may actually result in increased patient suffering during the dying process. Although we have a basic covenant to offer food and water to patients, we recognize that the provision of enteral or parenteral nutrition may not be indicated in patients who are clearly and irreversibly deteriorating, who are beyond a reasonable hope of recovery, and in whom death appears imminent.
In such cases, it is ethically permissible to withhold or withdraw nutrition and hydration, in full consideration of patient and family wishes.
However, we believe that physicians, other health professionals, and health care facilities should initiate and continue nutritional support and hydration when their patients cannot feed themselves. We are concerned that demented, severely retarded, and comatose individuals are increasingly viewed as "useless mouths." We reject this dehumanizing phrase. Rather than encouraging physicians to withhold or withdraw such patients' food and water, we encourage physicians to respond to God's call for improved physical, social, financial, and spiritual support of all vulnerable human beings.
The issue of the treatment of patients in coma or in persistent vegetative state (PVS) is part of the ongoing deliberations of the Ethics Commission and CMDA. A separate statement on this problem is under discussion.
Approved by the CMDA House of Delegates
May 3, 1990. Toronto, Canada.