Ethical Issues related to End of Life Treatment in Patients with Advanced Dementia – The Case of Artificial Nutrition and Hydration

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Esther-Lee Marcus
Ofra Golan
David Goodman


Patients with advanced dementia suffer from severe cognitive and functional impairment, including eating disorders. The focus of our research is on the issue of life-sustaining treatment, specifically on the social and ethical implications of tube feeding. The treatment decision, based on values of life and dignity, involves sustaining lives that many people consider not worth living. We explore the moral approach to caring for these patients and review the history of the debate on artificial nutrition and hydration showing the impact of the varying perceptions of the value of these patients' lives on changing norms. We argue that in light of the value of solidarity, decisions about life-sustaining treatment for patients with advanced dementia should be made on a case by case basis, as with any other patient, in consideration of the medical implications of the intervention which might best serve the goals of care for the individual patient.


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Marcus, Esther-Lee, Ofra Golan, and David Goodman. 2016. “Ethical Issues Related to End of Life Treatment in Patients With Advanced Dementia – The Case of Artificial Nutrition and Hydration”. Diametros, no. 50 (December):118-37.
Author Biographies

Esther-Lee Marcus, Hadassah-Hebrew University

Esther-Lee Marcus, MDGeriatric DivisionHerzog HospitalJerusalem 91035, IsraelHadassah-Hebrew University, Faculty of Medicine, Jerusalem, Israel


Ofra Golan, The Center of Academic Studies in or Yehuda

Ofra Golan, L.L.DHealth Care Law and EthicsThe Center of Academic Studies in or Yehuda2 Hayotzrim St, Or Yehuda, Israel


David Goodman, Hebrew University of Jerusalem

David GoodmanDepartment of PhilosophyHebrew University of JerusalemMt. ScopusJerusalem 9190501


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