Ethical biopsy

Artificially administered nutrition and hydration (AANH) often trigger complex decision-making that intersects medical technology, ethical practice, and legal responsibility. Inspired by ASPEN's 50th anniversary clinical ethics discussions, this article introduces the concept of an "ethical biopsy," a structured ethical inquiry process modeled after the diagnostic medical biopsy. By aligning medical and ethical criteria, this framework equips clinicians, nutrition support teams, and ethics committees with a compassionate and patient-centered method for resolving dilemmas. Just as a biopsy is invasive but necessary, confronting ethical dilemmas is a crucial but often uncomfortable process for reaching patient-centered decisions surrounding AANH, particularly at the end of life. A case report is presented of a patient with untreatable, advanced cancer who wishes to have parenteral nutrition with the goal of living longer and spending more time with her young children, although her medical team disagrees because of concerns for risk of infection. Components of an ethical biopsy are presented that can be used to resolve such an ethical dilemma.