ABSTRACT
Enteral and parenteral nutrition may provide sustenance to patients unable to eat or absorb food. Patients require this form of nutrition for a multitude of reasons that has led to a decline in their health, leading to death. Malnutrition is known to increase infection risk, lead to poor wound healing, prolong hospital stays, lead to multiorgan dysfunction, increase postoperative complications, and increase mortality. As in all aspects of medical decision making, one has to ask whether the benefit of a treatment outweighs its risks. The aim of providing hydration and nutrition is the perceived benefit. Yet the decision to start enteral nutrition and whether it will change mortality or improve quality of life is complex and is intertwined with much social, religious, and psychological conflict. Misperceptions remain among physicians, patients, and family members in regard to clinical tolerance to poor intake of nutrition and hydration in terminally ill patients, the risks and benefits of long-term tube feeding, and the ethical issues related to these treatments. The act of eating is of symbolic importance for patients and families. Family members associate food with health, and helping someone eat can be an important nurturing act. Thus, losing the ability to eat is felt to lead to starvation.1 The legal system over the last several decades has developed a framework of laws to help solve some of the nutritional choices that we have. This chapter will review and analyze these issues to aid in decision making for enteral nutrition.
