Food for thought : ethics and artificial nutritional support

A narrative ethics analysis is utilised to explore the nature and practice of the provision of artificial nutritional support. This technology is utilised in a variety of settings, with increasing acceptance of its efficacy and utility in health care. The administration of artificial nutritional support was originally intended as a transitory measure to allow for the restoration of a patient's normal digestive functioning. It is now, however, often provided to those who have irretrievably lost all higher brain functioning, people with terminal illness, and those with critical illness. Accordingly, the ethical analysis which is pursued embraces the multidisciplinary nature of the socio-political space which is artificial nutritional support. This modality of treatment has emerged as a site of contested ethics. Some commentators argue that providing nutrition regardless of route is a basic human function, symbolic of care, and constituting 'ordinary means' that should never be forgone. They also suggest that forgoing these techniques directly causes death, and are concerned about the social implications of depriving vulnerable people of basic human attention. Other authors suggest that the burdens of life with pain, discomfort, immobility, impaired consciousness, and loss of communication so overwhelm the benefits of life that there is no obligation to assist in sustaining life. Thus, a dichotomy of views exists. Different perspectives regarding the ethics of artificial nutritional support often depend on the model of health service delivery within which the author operates. Accordingly, research is undertaken which includes data from two distinct health service delivery systems. This research draws upon experience and literature within Australia, the United Kingdom and The United States of America, markedly different health care delivery systems that have been described as either 'socialised' or 'privatised'. This thesis is informed by interviews with 32 participants from diverse heath care disciplines, ranging from Intensivist to Chaplain. Drawing upon the richness of narrative, these interviews utilise the informants as experts from Australia, the United Kingdom and the United States of America. The findings from this research move well beyond the sphere of artificial nutritional support to encompass the practice of medicine and end-of-life care in general. Specifically the case is made for a cycle of care and communication practices, which assist us to debunk death myths regarding the inevitable painful tragedy of death, myths that inform the discursive shaping of contemporary health care