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June 14, 1995

Nutrition and Hydration for the Terminally III

Author Affiliations

Albert Einstein Medical Center Philadelphia, Pa

JAMA. 1995;273(22):1736. doi:10.1001/jama.1995.03520460018014

To the Editor.  —Dr McCann and colleagues1 are to be applauded for their attempt to ascertain whether terminally ill cancer patients who do not receive forced feeding, forced hydration, or parenteral alimentation experience the discomfort of hunger and thirst. The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research,2 the Hastings Center,3 and the US Supreme Court4 have supported the position that nutrition and hydration are medical treatments that may be withheld or withdrawn from consenting patients or with the consent of their surrogates. Families of terminally ill patients often have great difficulty forgoing nutrition and hydration. Physicians' own discomfort about forgoing nutrition and hydration contributes to making this decision an especially difficult one. Thus, in clinical practice, nutrition and hydration are considered by many to be comfort care that cannot be withheld or withdrawn. Clearly, understanding the parameters of

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