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Artificial Nutrition and Hydration: A critical analysis

In the last century, with the advent of plastic tubing, new ethical issues have been raised regarding nutrition and hydration of patients in comatose, or that of persistent vegetative states. By performing fairly simple procedures, artificial nutrition and hydration (AN&H) may be provided to almost all patients, including those unable to swallow.2 Therefore, patients who would otherwise imminently die may sometimes be kept alive for months or years. A Controversial issue that C.Pallis describes in his commentary on whole brain death is that of patients who are in persistent vegetative state (PVS). PVS, patients are not capable of voluntary action or behavior. They are not aware of their environment and do not have the capacity to experience pain or suffering.1 It is sometimes described as when a person is technically alive, but his/her brain is dead. However, that description is not completely accurate. In persistent vegetative state the individual loses the higher cerebral powers of the brain, but the functions of the brainstem, such as respiration (breathing) and circulation, remain relatively intact.4 Spontaneous movements may occur and the eyes may open in response to external stimuli, but the patient does not speak or obey

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