Total Parental Nutrition as a Proportionate Means of Conserving Life.

The seventh edition of the Ethical and Religious Directives for Catholic Health Care Services states, "In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally." Most of the discussions around medically assisted nutrition and hydration have focused on enteral nutrition. The present article aims to argue that the obligation to provide nutrition and hydration, in principle, extends to providing parenteral nutrition for patients who cannot take in food through their intestines so long as the intervention does not constitute a grave burden, does not entail excessive expense, and provides a reasonable hope of efficacy. There are several medical conditions in which either short- or long-term total parenteral nutrition (TPN) is required and is accepted as the standard of care. The inability to tolerate nutrition enterally should not be either a death sentence or a condonation of passive euthanasia via dehydration and starvation if death is not imminent. Fr. Tadeusz Pacholczyk, in discussing death and feeding tubes stated that, "Our death, in other words, should result from the progress of a pathological condition, not from a lack of food or water if it could have been readily and effectively offered to provide comfort and support to a patient." Proceeding with TPN is a proportionate method of assisted nutrition and hydration that has the potential to aid in the prolongation of life worth living, as well as preventing unnecessary death via dehydration and starvation.