Controverse « L'alimentation : un traitement ou un soin ? ». Réflexion éthique

There is currently a good deal of debate on how to call artificial feeding. Should one see in it a process of care or a medical treatment? It would however be a mere question of semantics if behind that question there were not another one: can one stop artificial nutrition of patients for whom it has been decided to stop the medical treatments? Calling artificial feeding a treatment would then justify stopping it. This way of reasoning has been introduced around 1990 in order to justify stopping artificial nutrition of patients in a “persistent vegetative state”. A number of objections can however be raised here. It is first doubtful that one can consider the two questions as identical. Moreover, the European tradition of ethics has for long insisted on the specific importance of feeding in the care of sick people. The goal of care is to respond to the needs of a person who can no longer satisfy them by itself. This implies providing the food required for sustaining life and, if necessary, giving assistance to the sick people who have to be helped in order to eat. Tube feeding compensates the difficulty to swallow, not the process of nutrition which may be intact. It sustains life by simple means, it can be supplied at home by the family. It thus deserves to be called a process of care, but this does not oblige to resort to it in all cases in which oral feeding has become impossible. Quite often, especially in geriatrics and palliative care, it would hardly contribute to sustain life and it would be the cause of various kinds of discomfort, hardship and even vital risk. It is not the same in stable states as is in most cases the vegetative state.