[Artificial nutrition and hydration: basic care or medical therapy]

The development of the healthcare systems has spread the use of artificial nutrition, both parenteral and enteral, as a solution for all the problems related to those diseases that prevent oral nutrition. The need for hydration and nutrition is a basic one for humans and its fulfilment is generally considered an ordinary care, always due, however the techniques of artificial nutrition raise the question whether they can be considered therapy that can be with holded or withdrawed according to criteria that avoid useless abuses (therapeutic fury). From an ethical point of view it is very important to define the futility (a term that comprises the evaluation of the proportionality, the adequacy and the ordinariness) of the means that medicine can offer. In the reviewed clinical studies the resort to artificial nutrition and hydration is justified only as a means of improving the quality of life, while the medical decision making on the usefulness or uselessness of a treatment must take into account the efficacy of the cure from a clinical point of view and its endurance by the patient and the caregiver. The adequacy and the proportionality of the cure or of the nutritional therapy do not depend thus on the disease or its stage, but on the clinical situation of the patient, on his caregivers and on the competence of the medical staff.