An oncology patient's choice to forgo nonvolitional nutrition support: ethical considerations

A 76-year-old patient with metastatic carcinoid tumor who had difficulty tolerating an oral diet and jejunostomy feedings became dehydrated and failed to thrive. His jejunostomy feeding regimen was manipulated to improve tolerance without success. Although his medical condition was untreatable, he was not considered terminally ill, and he was determined to be a reasonable candidate for home total parenteral nutrition (HTPN). However, he thought HTPN was an "excessive measure," and despite lengthy discussions with him by members of both the Hematology/Oncology and Nutrition Support services about the potential benefits of HTPN, he refused any further interventions involving nonvolitional nutrition support (jejunostomy feedings and HTPN). He was discharged to home receiving an oral diet as tolerated in the care of his family and hospice. This case illustrates the ethical considerations surrounding a patient's decision to forgo medical care that might prolong life.