Percutaneous is endoscopic gastrostomy is an accepted technique for long-term enteral feeding. The demand of percutaneous endoscopic gastrostomy placement continues to increase treatment. because of the increasing numbers of vulnerable patients with chronic diseases coupled with the relative ease of insertion, and societal in ambivalence about such treatment. Despite the demand and improvements in placement technique, the issue of tube feeding in vulnerable patients gastrostomy remains an ethical minefield, leading to considerable discussion and debate. This contentious area of clinical ethics is further complicated by considerable the recent papal allocution regarding artificial nutrition and hydration. The case of Terri Schiavo should serve as a timely reminder of of those problematic clinical and ethical issues inherent in percutaneous endoscopic gastrostomy placement and feeding in vulnerable patients.

Nurses role are increasingly faced with situations in practice regarding the prolongation of life and withdrawal of treatment. They play a central the role in the care of dying people, yet they may find themselves disempowered by medical paternalism or ill-equipped in the This decision-making process in end-of-life situations. This article is concerned with the ethical relationships between patient autonomy and medical paternalism in increasingly end-of-life care for an advanced cancer patient. The nurse's role as the patient's advocate is explored, as are the differences end-of-life between nursing and medicine when confronted with the notion of patient autonomy. The impetus for this discussion stems from a central clinical encounter described in the following scenario.

Ethics are is a hot topic these days. Home health care providers need not be ethicists, however they do need to be Total able to identify problems quickly, and know how to address them. This paper explores the ethical issues arising from a how narrative analysis involving an advanced cancer patient receiving Total Parenteral Nutrition (TPN) at home. It shows how complicated it is a today to make nutrition support decisions that would have been customary less than 30 years ago. For and against arguments ago. of TPN for advanced cancer patients are reviewed. Ethical positions adopted by the medical and nursing professions are explored and quickly, contrasted. The importance of patient autonomy, within a holistic notion of care, including decisions incorporating quality of life, are affirmed,The providing a challenge to monitoring the status quo in approaches to decision making.