Morality is a code of conduct which is followed by members of a civilized society.

Here are some practical "rules" for making moral decisions regarding the provision or withdrawal of food and fluids, whether the patient is fed orally or through a tube:

1. While inserting a feeding tube may require surgery or other medical expertise, food and fluids themselves are not medical treatment because they do not cure; they sustain life.

2. Removing food and fluids from those able to eat and drink on their own or with the assistance of another person is never appropriate.

3. Tube-feeding persistently non-responsive patients is obligatory in most cases since it is beneficial and usually does not add a serious burden.

4. For terminally ill patients, the provision of food and fluids is generally obligatory (required because it is necessary and ordinary) care.

5. When death is so close that further nutrition and hydration will no longer sustain life, they may be discontinued if the patient is more comfortable without them.

6. It is most important to examine intent. Is the intention to hasten or cause death? Then the omission of food and fluids is inappropriate and morally unethical.

[July/August 2002; reprinted in Illinois Nurses for Life News]