Under what conditions is withholding or withdrawal of artificial nutrition and hydration ethically permissible?

• A. When it aligns with patient wishes or best interests, and when continued nutrition/hydration is not medically beneficial or burdensome
• B. Only when a physician disagrees with patient
• C. Never permissible
• D. Only in terminal illness with no remaining quality of life

Answer: (A)

Withholding or withdrawing artificial nutrition and hydration is ethical when it respects what the patient wants or what would be best for them, and when continuing would not provide meaningful medical benefit or would create burdens. This rests on honoring patient autonomy—if a capable patient can express a preference to discontinue ANH, that choice should be respected—and on beneficence and non-maleficence, by avoiding treatments that prolong suffering or a dying process without a reasonable chance of benefit. When capacity is lacking, a surrogate should decide based on the patient’s known wishes or, if unknown, in the patient’s best interests.

So, this can be ethically permissible even outside terminal illness if continuing ANH no longer benefits the patient or imposes undue burden. It’s not about a physician’s disagreement, and it’s not true that it’s never permissible, or that it’s limited only to terminal cases.