Beyond principlist autonomy: The moral meaning of feeding and parenteral nutrition in palliative cancer care.

Parenteral nutrition (PN) in palliative oncology presents profound ethical challenges where the desire to nourish intersects with dependency, vulnerability, and the limits of medicine. For patients with incurable malignancy who cannot maintain nutrition enterally, PN may extend life for months yet impose significant physical, emotional, and moral burdens on patients and families. Prevailing principlist frameworks privilege a thin, procedural conception of autonomy that fails to capture the interdependence inherent in these situations. This essay argues that relational autonomy, enriched by virtue ethics and guided by phronesis (practical wisdom), provides a more ethically adequate foundation for PN decision-making. Relational autonomy recognises autonomy as embedded within relationships of care and trust, while phronesis enables clinicians to exercise moral discernment amid uncertainty and cultural diversity. Together, these approaches reframe feeding from a technical intervention into a relational act of care, demanding wisdom, compassion, and humility at the end of life.