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Abstract

A narrative ethics analysis is utilised to explore the nature and practice of the provision of
artificial nutritional support. This technology is utilised in a variety of settings, with
increasing acceptance of its efficacy and utility in health care. The administration of
artificial nutritional support was originally intended as a transitory measure to allow for the
restoration of a patient's normal digestive functioning. It is now, however, often provided to
those who have irretrievably lost all higher brain functioning, people with terminal illness,
and those with critical illness. Accordingly, the ethical analysis which is pursued embraces
the multidisciplinary nature of the socio-political space which is artificial nutritional support.
This modality of treatment has emerged as a site of contested ethics. Some commentators
argue that providing nutrition regardless of route is a basic human function, symbolic of
care, and constituting 'ordinary means' that should never be forgone. They also suggest
that forgoing these techniques directly causes death, and are concerned about the social
implications of depriving vulnerable people of basic human attention. Other authors
suggest that the burdens of life with pain, discomfort, immobility, impaired consciousness,
and loss of communication so overwhelm the benefits of life that there is no obligation to
assist in sustaining life. Thus, a dichotomy of views exists. Different perspectives
regarding the ethics of artificial nutritional support often depend on the model of health
service delivery within which the author operates. Accordingly, research is undertaken
which includes data from two distinct health service delivery systems. This research draws
upon experience and literature within Australia, the United Kingdom and The United States
of America, markedly different health care delivery systems that have been described as
either 'socialised' or 'privatised'.
This thesis is informed by interviews with 32 participants from diverse heath care
disciplines, ranging from Intensivist to Chaplain. Drawing upon the richness of narrative,
these interviews utilise the informants as experts from Australia, the United Kingdom and
the United States of America. The findings from this research move well beyond the
sphere of artificial nutritional support to encompass the practice of medicine and end-of-life care in general. Specifically the case is made for a cycle of care and communication
practices, which assist us to debunk death myths regarding the inevitable painful tragedy
of death, myths that inform the discursive shaping of contemporary health care.

Item Type:	Thesis - PhD
Authors/Creators:	Breier-Mackie, Sarah Jane
Keywords:	Medical ethics, Artificial feeding, Terminal care
Copyright Holders:	The Author
Copyright Information:	Copyright 2002 the Author - The University is continuing to endeavour to trace the copyright owner(s) and in the meantime this item has been reproduced here in good faith. We would be pleased to hear from the copyright owner(s).
Additional Information:	Thesis (Ph.D.)--University of Tasmania, 2002. Includes bibliographical references
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