Aspects éthiques de la nutrition en fin de vie

Nutrition and hydration at the end of life is a complex subject linked to many controversies. The artificialized aspect of these practices justifies questioning that focuses on the indication and limitation concepts. The benefits are overstated due to strong social and religious representations. For the same symbolic motives, technical constraints are underestimated and the limitation of such care remains difficult to design and to implement in many situations. This is particularly the case for the elderly, patients in vegetative state and newborns with severe brain damage. The combination of such a limitation with sedation raises other questions, especially if one refers to a systematic aspect based on a precautionary approach as suggested by some recent legislation to amend the law. The concern for a reasonable proportionality of care nevertheless requires keeping singular open answers and not generalizing any practice. A difficult decision justifies dialogue and the actors who are confronted with it have to resolve ethical dilemmas as a team. They must be trained in the ethics of discussion and have some knowledge in identifying these dilemmas and support arguments.