Artificial nutrition at the end of life and ethical difficulties

Introduction. - Artificial nutrition at the end of life is a complex subject. it raises many questions and refers to different symbols linked to society, ethics, care and many others. Methods. - This article reports the case of a complex situation of artificial nutrition decision in an adult with trisomy 21 and in a palliative situation. Results. - The decision to start or not artificial nutrition is not, in these situations, a medical certainty. All care providers and non-caregivers must then interact in order to define the least harmful solution for the patient because very often there are arguments for and against artificial nutrition. The suffering and the representations of the relatives are also imperative elements to take into account and support throughout the decision-making process must be provided. Conclusion. - The final decision of artificial nutrition in a complex situation must be made after a global consultation of all medical and non-medical actors. It has to be explained to everyone and an appropriate support must then be offered to the patient and his family as well as a regular reassessment of care and comfort. (C) 2019 Elsevier Masson SAS. All rights reserved.