Hydration and Nutrition; A Basic Human Need, Not an Option of Medical Care.

There has been a recent striking reversal of the previous almost universal consensus concerning a patient's right to receive nutrition and hydration even when surgical or highly technological medical intervention was discontinued as ineffective, after consultation with the patient or family.

The reasons that food and water should not be considered an option of medical care are summarized as follows:

1. All patients, no matter how severe or hopeless their illness, have the basic right to nursing care, emotional support, food, and water.

2. Hydration and nutrition are biological necessities. Food and water are not medications. We go into the kitchen, not to the pharmacy, for dinner.

3. Unlike all other modalities of care (e.g., antibiotics, cardiac drugs, etc.), the withdrawal of hydration and nutrition is universally fatal. Death will occur within a predictable time, usually within 10 to 14 days. There are no survivors. This means the doctor, not the disease, kills the patient. Withdrawal of water is essentially a homicidal act. A hospital is an inappropriate place to kill a patient. The lethal impact of the order to withdraw fluids is well understood by nurses, hospice staff, and hospital personnel. It is neither fair nor appropriate to involve health care professionals in hastening the death of a patient.

4. Unlike respirators, dialysis, and other technology, "artificially administered" nutrition and hydration are not burdensome or painful. If long-term support is contemplated, a percutaneous gastrostomy (done by a gastroenterologist, not a surgeon) offers the alleviation of hunger and thirst without discomfort. There is no substance to the argument that fluid may represent a risk to some patients. In instances of renal or cardiac failure or cerebral edema (swelling of the brain), hydration may be temporarily decreased but is not discontinued.

5. The cost of a gastronomy feeding, itself, is minimal. In some cases, the formula may be simply prepared in a blender. Family or nursing home personnel may administer the feeding. The patient may resume oral feedings if he or she improves.