AMERICAN  MEDICAL ASSOCIATION (AMA)
515 North State Street
Chicago, IL 60610

(312) 464-5000

Organizational overview:  The AMA is probably the oldest (founded in 1847), certainly the best known, and arguably the most influential medical organization in America, today.  Well over half of the approximately 460,000 physicians licensed to practice medicine in the United States today belong to the AMA.  The AMA -- an organization which is often described (and criticized) as more conservative than the members it purportedly represents (Cummings and Wise 1989: 252) -- periodically issues position statements authored by a standing multi-disciplinary committee of physicians and support personnel known as the Council on Ethical and Judicial Affairs. 

Position on tube feeding at the end of life

The distinction between “ordinary” and “extraordinary” treatments has been used to differentiate ethically obligatory vs. ethically optional treatments.  In other words, ordinary treatments must be provided while extraordinary treatments may be withheld or withdrawn.  Varying criteria have been proposed to distinguish ordinary from extraordinary treatment.  Such criteria include customariness, naturalness, complexity, expense, invasiveness, and balance of likely benefits and burdens of the particular treatment.  The ethical significance of all these criteria essentially are subsumed by the last criterion -- the balance of likely benefits vs. burdens of the treatment (Council 1992: 2230) . . . . 

For example, artificial nutrition and hydration has frequently been cited as an objectively ordinary treatment which, therefor, must never be foregone.  However, artificial nutrition and hydration can be very burdensome to patients. Artificial nutrition and hydration immobilizes the patient to a large degree, can be extremely uncomfortable (restraints are sometimes used to prevent patients from removing nasogastric tubes), and entails serious risks. . . . [I]t is far from evident that providing nutrition through a nasogastric tube to a patient for whom it is unwanted is comparable to the typical human ways of feeding those who are hungry (Council 1992: 2230-1). 

In some cases, terminally ill patients voluntarily refuse food or oral fluids.  In such cases, patient autonomy must be respected, and forced feeding or aggressive parenteral rehydration should not be employed.  Emphasis should be placed on renewed efforts at pain control, sedation, and other comfort care for the associated discomfort (Council 1994: 96).

Citations

Council on Ethical and Judicial Affairs (Council). 1992. "Decisions Near the end oflife," Journal of the American Medical Association, Vol. 267, pp. 2229-2233.

 _____. 1994. "Physician Assisted Suicide," Issues in Law and Medicine, Vol 10, pp. 91-97.