The Right to Nutrition and Hydration: A Need for Vigilance

Response to Allen G. Sandler's (2009) Article, “The Right to Nutrition and Hydration: A Need for Vigilance”

“…Allen Sandler (2009) argued appropriately about the need to be cautious before concluding that the sudden onset of lethargy, lack of responsiveness, noncommunication, and refusal to eat or drink in a severely intellectually disabled person signals a terminal illness that justifies transfer to hospice. I am concerned, however, that he believed the intervention required in this scenario was the placement of a gastrostomy tube (I assume that he means a percutaneous endoscopic gastrostomy [PEG] tube.)…”

“…To illustrate his point, Sandler (2009) described the case of a 49-year-old woman named Alice with congenital hydrocephalus, blindness, and profound intellectual disability, who ''for unknown reasons…became lethargic and unresponsive, stopped talking, and stopped eating and drinking'' (p. 234). Sandler stated that she had had a complete medical evaluation, ruling out any acute infectious process, metabolic derangement, intracranial process, or other potentially treatable condition.…”