Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
The use of artificial nutrition and hydration (ANH) has become relatively commonplace. With the development of the PEG years ago, the difficulties that surrounded the use of naso-gastric feeding tubes have all but disappeared. However, the clinical, ethical and legal aspects of ANH have replaced issues of procedural techniques and the discomfort experienced by older patients when the nasogastric tubes were used for prolonged periods. Many in the field of aging and long-term care in particular are particularly sensitive to the long-term implications for the patient and family once ANH is implemented. The issues of starting such intervention when its discontinuation may cause moral conflict, legal challenges and for many who are believers religious conundrums must be considered especially when such decisions are being made during a period of crises and clinical uncertainty.
Key Words: artificial nutrition, hydration, long-term care, implications.