Removing the feeding tube: a procedure with a contentious past

When tragic circumstances force families to focus on an individual's right to refuse treatment, society is forced to reexamine its views on life and death; these circumstances may result in legal rulings and state statutes. During media coverage of high-profile cases, reporters frequently used distinct terms like "brain dead," "persistent vegetative state," and coma interchangeably, but they are clinically different. Today, most bioethicists believe the right to refuse treatment is legally and ethically settled, but decision-making in individual circumstances often may remain less clear and emotionally charged. Even in the best situations, abatement of nutrition during the end-stage of illness continues to be difficult, often colored by religious, cultural, and racial or ethnic perspectives. Decision-making to withhold or withdraw feeding tubes for younger patients is even more difficult and raises many additional questions. Once a decision to withdraw a feeding tube is made, clinicians and the patient's loved ones need to know what to expect.