Advance care planning is important to ensure that patients, when competent,
can influence the kind of medical care they receive if they lose
decision-making capacity. Because decisions by surrogates to forgo nutrition
support remain controversial, specific inclusion of artificial nutrition and
hydration as a part of advance care planning has taken on growing importance.
This article reviews the choices about artificial nutrition and hydration that
are possible using conventional advance directives such as the living will,
the instructional directive, values histories, and combination directives. It
summarizes the legal basis for such documents. It also describes the ways that
physicians' orders to limit treatment can help implement decisions about the
use of artificial nutrition and hydration. Finally, it stresses the importance
of clarifying with patients and families the risks and benefits of nutrition
support in a variety of common situations such as advanced dementia and
metastatic cancer as an essential prerequisite to meaningful advance care
planning.
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