Artificial feeding: the least restrictive alternative?

Of all the reasons that justify a decision to withhold or withdraw a feeding tube, the most basic is that it is not needed in order to nourish the patient adequately and safely. The controversy that surrounds feeding tubes decisions in the so-called right-to-die context has distracted attention from this aspect of their use. This creates the risk that they will be initiated inappropriately, without adequate evaluation or consent. By re-incorporating the concepts of medical indication and the least restrictive alternative doctrine into the consent process, as new federal regulations require, physicians can restore balance to clinical judgment and deter improper practices. In order for these concepts to make a real difference to patients and physicians, society must improve the quality of care it provides the elderly.