Feeding policy protects patients' rights, decisions

In adopting a policy to guide patients and care givers in treatment decisions, the Carmelite Sisters for the Aged and Infirm, Davenport, IA, have taken an important step toward resolving issues related to force-feeding. The policy enables residents of Kahl Home for the Aged and Infirm to discuss their future health care with relatives and physicians while they are competent. It also establishes guidelines concerning the insertion of feeding tubes and provides for periodic evaluation of residents' feeding needs. Formulating such a policy, of course, requires consideration of the ethical assumptions underlying decisions to withdraw or withhold life-sustaining therapy. It requires an understanding of the difference between a diminished capacity to pursue life's ends and the complete inability to do so when a person is permanently comatose. this difference affects the decision as to whether it is time to allow one to die--a decision that should precede the medical decision to withhold or withdraw treatment. For example, to present as an option the removal of feeding tubes and intravenous equipment when a patient is brain dead is poor medicine and bad ethics. The patient is dead; thus no choice exists whether to end treatment. Despite objections to decision making based on quality-of-life criteria, this concept--when related to a person's ability to pursue life's temporal goals--is critical to good decision making and allows decision makers to avoid arbitrary judgments in determining when it is time to let a person die.