Efforts to define policies on withholding and withdrawing life-sustaining procedures from hopelessly ill patients are a recent development in U.S. Many states in U.S. have legislations about this issue. A report of "guidelines on the termination of life-sustaining treatment and the care of the dying" was published in 1987 by the Hastings Center. In Taiwan, we do not have such policies and guidelines. It is easily justified to withhold or withdraw high-tech medical treatment from hopelessly or terminally ill patients such as a respirator or a dialysis machine. But food and water from IV line or naso-gastric tube are so central to an array of human emotions that they have a symbolic and psychological significance. The artificial nutrition and hydration symbolize our caring for and nurturing of the patients in our culture. And also, once a treatment is initiated there is a reluctance to discontinue it.
According to Beauchamp & Childress (1983), whether a particular treatment is obligatory depends on whether it serves a patient's best interests, including interests in comfort and in having his/her autonomous wishes carried out. Nevertheless, arguments or justifications for continuing patients' artificial nourishment commonly address the issue from ethical, medical,and legal aspects. Very few hospice staff think that withholding and withdrawing artificial nutrition and hydration are ethically justified in Taiwan. Also, the families of the patients usually have a bond created by" doing something rather "standing by", no matter how ineffective their actions. The expectation of nourishment is essential to maintain the trusting relationship between patient/families and physician. The risk of law suit and lack of clear guidelines or policies to make this issue very difficult to deal with.
