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Editor's Correspondence |

The Ethical Requirement to Provide Hydration and Nutrition—Reply

Thomas I. Cochrane, MD, MBA; Robert D. Truog, MD
Arch Intern Med. 2006;166(12):1324-1325. doi:10.1001/archinte.166.12.1324-b.
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The central claim of our Commentary was that the right to refuse an intervention does not depend on the “artificiality” of the intervention.1 Baumgartner does not offer a refutation of this claim. His letter, therefore, amounts to an assertion that the incapacitated patient's right to refuse hydration and nutrition violates some unspecified “fundamental truth and morality.”

The arguments for this right are straightforwardly based on 2 simple and completely uncontroversial principles. The first principle is that patients with decisional capacity have the right to refuse any unwanted intervention—including nonartificial life-sustaining therapies such as oral hydration and nutrition. We are unaware of any mainstream opinion to the contrary. The second principle is that incapacitated patients retain all of the rights they possessed before losing decisional capacity. This principle is the very embodiment of “humanistic” respect for the incapacitated, “defenseless” patient: if the cognitively normal patient has a right to refuse oral hydration and nutrition, then so does the cognitively impaired patient.

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