Invited Review The Use of Advance Care Planning to Guide Decisions About Artificial Nutrition and Hydration

ABSTRACT: Advance care planning is important to ensure that patients, when competent, can influence the kind of medical care they receive if they lose decision-making capacity. Because decisions by surrogates to forgo nutrition support remain controversial, specific inclusion of artificial nutrition and hydration as a part of advance care planning has taken on growing importance. This article reviews the choices about artificial nutrition and hydration that are possible using conventional advance directives such as the living will, the instructional direc-tive, values histories, and combination directives. It sum-marizes the legal basis for such documents. It also describes the ways that physicians ’ orders to limit treat-ment can help implement decisions about the use of artificial nutrition and hydration. Finally, it stresses th