Permanently Unconscious Patients and the Ethical Controversies Surrounding Artificial Nutrition and Hydration: Getting the Facts Straight

The provision or otherwise of artificial nutrition and hydration (AHN) is, and has been for some years now, a matter of great controversy. The issue of ANH is made more complex when the patient is incompetent, that is to say, incapable of ever making a free and infonned choice as to its provision or otherwise. The pennanently unconscious patient, and in particular, the persistent vegetative state patient (PVS) and the comatose patient are two examples of incompetent patients for whom the resolution of this very complex issue has important life and death consequences. We believe that movement towards an early ethical resolution of the ANH controversy is unlikely, at least in the case of the pennanently unconscious patient, for a number of reasons. First, existing confusion engendered by differing interpretations of what constitutes effective treatment and whether in fact ANH itself is a medical treatment, or, simply part of the ordinary nursing care owed to all patients unconscious or not. Second, there are the ambiguous meanings and time limits of commonly used terms such as imminent death, terminal condition and dying. Third, the number of different terms used to describe the medical status of the pennanently unconscious, for example, persistent vegetative staJe, coma, comatose,