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

Informed consent is a legal procedure when including a person in the treatment, diagnostics or research which includes information, voluntarism and capacity to consent of the participant. Capacity to consent is related to decision-making process and could be influenced by various factors. Assessment of capacity to consent is still clinical, because there are no widely accepted standards and assessment instruments. Persons with mental disorders could have some deficits in capacity for decision-making that could be temporary or permanent. Ethical considerations in the research with participants not able to consent are related to benefit vs. non-benefit studies and risk assessment. Finding of the better methods for capacity assessment and capacity enhancement could improve selection of the research participants. Legal recommendations, including international declarations and conventions, as well as the related Croatian laws are important mechanisms for safeguards of the persons with mental illness in biomedical research.

HISTORY AND ADMISSION FINDINGS: A 26-year-old woman was admitted because of excessive weight loss: her body mass index was 11.3 kg/m (2). She reported an adequate food intake and denied fear of gaining weight. INVESTIGATIONS: The leukocyte count on admission was 2.0/nl. Bone marrow biopsy showed gelatinous bone marrow transformation with hypocellularity. Psychiatric examination and observation of the patient's eating behavior revealed symptoms typical of anorexia nervosa. DIAGNOSIS, TREATMENT AND COURSE: Because of the diagnosis of anorexia nervosa behaviour therapy was started. During the following months the patient continually gained weight. But it took nine months for leukocyte count to be normal, by which time her body mass index had risen to 17.8 kg/m (2). CONCLUSION: Severe weight loss in anorexia nervosa may lead to leukopenia and gelatinous bone marrow transformation. The abnormal leukocyte count can become normal by maintaining body weight within the normal range.