Minimal Comfort Feeding - New End-of-Life Option

It is a pleasure to see "minimal comfort feeding" (MCF) getting more attention as an end-of-life option, for example, here in the New York Times. 

MCF both(1) permits patients to avoid living into late-stage dementia and (2) mitigates moral distress among caregivers they might otherwise endure from underfeeding (VSED) or overfeeding (CFO) the patient.

Clinicians are implementing MCF. And commentators are examining it. One author group suggests distinguishing MCF into two separate concepts:

Proportionate Comfort Feeding (PCF) - Nutrition and hydration provided for comfort with the understanding that it may hasten death. Death is foreseen but unintended.

Minimal Feeding to Hasten Death (MFHD) - Nutrition and hydration is given only in response to signs of hunger and thirst. Death is intended.

Unfortunately, the two cases they use to drive this analysis involve one patient with cancer and a second capacitated patient with ALS. But our core article on MCF clarifies that "MCF is initiated only (1) after a patient’s advanced dementia is established (e.g., is consistently at Stage 7A or beyond using the FAST, or at stage 7 on the Global Deterioration Scale)."

John Y. Rhee