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ETHICS IN MEDICINE   University of Washington School of Medicine

Termination of Life-Sustaining Treatment:
Case 2 Discussion

Patients with metastatic cancer often suffer from profound cachexia, attributable to the metabolic effects of their cancer and their inability to get adequate caloric intake from eating alone. TPN is able to provide protein and nonprotein nutrients to reverse the catabolic effects of illness. TPN has a number of potential complications, such as those related to infection from the central line catheter site.

In this case, you should carefully evaluate the goals of therapy as they relate to TPN. Is TPN likely to offer the patient any benefit? If her life expectancy can be prolonged with additional chemotherapy, it may be reasonable to give TPN to allow the patient to enjoy that benefit. If additional chemotherapy offers no substantial increase in quantity or quality of life, TPN could become another burden for the patient without any meaningful benefit, and ought to be withheld.

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