"You can't be any poorer than dead": difficulties in recognizing artificial nutrition and hydration as medical treatments.

Abstract

The President's Commission Report Deciding to Forego Life-Sustaining Treatment comes down squarely in favor of two propositions: 1) artificial provision of nutrition and hydration are medical treatments, and 2) as such, these medical treatments may be foregone by certain categories of patients or their proxies. This latter conclusion is based on roughly consequentialist grounds; the former is more assumed than argued There is a school of thought opposed to both of these conclusions. After first demonstrating that nourishment is not medicine, a non-consequentialist or natural law argument is employed to show that nourishment may not be foregone insofar as it violates the principle, “First, do no harm.” I was once a member of this school, and this paper was to argue its position. In the end, however, this paper adopts the position that artificial provision of nourishment and hydration can be medical treatments, and as such may be foregone by certain categories of patients, without violating a natural law understanding of “First, do no harm “Still, exposing my retained sympathies for my former position, the paper attempts to argue for a very careful standard for non-treatment. As a result, the argument of the paper takes four steps. First, I present the argument that artificial provision of nutrition is never medical treatment, giving as much strength to that argument as possible. Second, I show how the focus of that argument leads it astray, and that artificial provision of nourishment is medical treatment. Third, I try to show by what standard patients (or proxies) can legitimately forego this medical treatment Fourth, I point out where my former position has valid criticisms of certain arguments used by those who hold that such treatment may be withdrawn, and urge great caution in deciding to forego treatment.