Confronting conflict. A nursing home staff comes to grips with an elderly patient's decision to refuse nutrition.

For the most part, cases involving young or middle-aged persons such as Nancy Cruzan and Paul Brophy have shaped the legal and ethical landscape regarding the obligation to provide nutrition and hydration to nutritionally compromised patients. But the issue of care givers' responsibility in this area also arises frequently in the long-term care setting. One of the most difficult situations to address is what to do when an elderly patient begins to refuse adequate nutrition. Staff at Apartment Community of Our Lady of the Snows, Belleville, IL, had to wrestle with this question when Jane, a 90-year-old resident, decided her life had become too unbearable to continue. She refused to eat and demanded that nutrition not be forced on her. As they considered her situation, staff had to ask whether they clearly understood Jane's position, what actions would be in her best interest, what their professional obligations were, what they could do if her decision conflicted with professional or institutional values, and whether Church teaching shed any light on the issue. Unable to devise an alternative course of action acceptable to Jane, staff eventually acquiesced to Jane's request. Although they realized the difficulty of knowing with certainty what the right course of action is in such a case, they found support for their decision in Church teaching and in legal rulings on conflicts between the state's interest in preserving life and a patient's right to privacy.