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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


1. "Coma and persistent vegetative state" Http://healthlink.mcw.edu/article1921394859.html. Medical

Consequently, the first point of debate would be whether there is ever a time that AN&H can ethically be withdrawn. For those that emphasize God's 'miraculous interventions' and our inability to predict the future, possibly the answer would be "No." We should remain true to our moral convictions and act accordingly when it comes to patients with PVS and loved ones. These ethicists have not determined the issue of when the patient is considered clinically dead in the sense of higher or whole brain functioning. Should there be a definition of death in place? The constant debate over whether the PVS patient in loss of higher brain death, should in fact be let off AN&H is a struggle that Philosophers and Doctors continue to debate. If I were to be in the PVS position, the answer would be to let me live until 'natural' forces take my life, for the hopeful fact remains that regaining spontaneous consciousness perhaps could prevail. Can the medical profession or Harvard ad hoc committee hold the upper hand in making such definitions in light of such speculation as to whether there is a definition for such a finite state?

2. Scott B. Rae, "Moral choices; An introduction to ethics" Grand Rapids, MI: Vandervan Publishing 1995.

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Approximate Word count = 979
Approximate Pages = 4 (250 words per page double spaced)


  

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