Reply to "Comments on the Ethics Corner"

Abstract

We thank Dr. Iraqi, et al., for their thoughtful comments about the case of Mrs. L. Dr. Iraqi argues that the treatment team failed to honor Mrs. L's previously expressed wish that food and fluid be withdrawn in the event of cognitive impairment and wonders whether the team might have been more comfortable about withholding nutrition if she had had cancer rather than advanced dementia. At issue is the interpretation of the living will that stated Mrs. L. “wished to have food and fluid withdrawn in the event of [irreversible] loss of cognitive function.” Both the treatment team and the ethics consultants felt this statement meant that artificial nutrition and hydration, which are recognized to constitute medical therapy, should be withdrawn. However, they felt that they were morally obligated to offer Mrs. L. food and drink, regardless of her underlying diagnosis. If she declined, she would not be compelled to take nutrition via a gastrostomy tube, nasogastric tube, syringe feeding, or parenteral nutrition. The primary care physician who took over the case, who was not the original treating physician, concurred with this view but arranged for hospice care to help support the family.