Vol. 26:2 summer 2010
on the nature of tube feeding: basiC
Care or mediCal treatment?
E R I K M . C L A R Y, M D I V , M A
Abstract
Five years following the Terri Schiavo affair, and almost twenty since the issue of
tube feeding first came to the national scene in the case of Nancy Cruzan, the debate
over withdrawing this manner of care from patients with severe cognitive impairment
continues. One question that frequently arises in the discussion over the ethics of tube
feeding involves the matter of categorization—is tube feeding basic or medical care? At
its most fundamental level, this question requires an empirical judgment that is distinct
from, though not irrelevant to, the ethical question (When, if at all, is it permissible
to forego or withdraw tube feeding?). In this article, the nature of tube feeding is
considered in light of the evidence that has accumulated in the published literature since
the procedure was first reported in 1951. That evidence reveals tube feeding to bear
several hallmarks of medical therapy, including its direction toward the sick and not the
healthy, the application of medical knowledge and skills, the surgical implantation of a
foreign body intended to counter the effects of debilitating disease, and the exposure of
the recipient to significant risk of complications directly related to the intervention. It is
concluded that tube feeding is properly considered medical care. Arguments for viewing
tube feeding as basic care, which generally focus on the nature of the infusate or the
personnel required to administer it, are addressed.
With the rapid advance of medical technology in the past century, a host of ethical
challenges have arisen for which society has been ill-prepared. One of the more
controversial medico-ethical cases in recent memory is that of Terri Schiavo, a patient
diagnosed with severe brain damage who received nutritional support for fifteen years
up until her estranged husband finally prevailed in his effort to have her feeding tube
removed, prompting her death due to dehydration thirteen days later. Among the ranks
of those critical of the decision to remove Mrs. Schiavo’s feeding tube was Mary
Porta, who received national attention by carrying with her to rallies a giant, five-
foot Styrofoam spoon.1 Ms. Porta’s point was significant as it reflected a widely held
notion that the provision of nutrition and hydration through artificial means constitutes
“basic” (“ordinary” or “normal”) care. Pope John Paul II was certainly an advocate of
this approach to classifying artificial feeding, stating in 2004 that “the administration
of water and food, even when provided by artificial means, always represents a natural
means of preserving life, not a medical act. Its use, furthermore, should be considered in
principle ordinary and proportionate . . .”2
Are Pope John Paul II and Ms. Porta to be granted their presuppositions concerning
the nature of artificial feeding? If they are, then the question concerning tube feeding
really becomes one of when, if at all, is it morally permissible to deny a person basic care?
If, however, there is a cate