Care decisions and choices at the end of life can confront patients and families with a myriad of challenges that could threaten their physical, psychological, social and spiritual well-being (1). Many individuals in society fear prolonged and painful deaths—and as such have placed reliance on the use of advance care directives and explicit conversations with family, to ensure their wishes are known and that their autonomy is preserved at that vulnerable moment and beyond, when they have lost decisional capacity and can no longer direct care for themselves.
This paper will examine the unique issues raised at the interface between law and ethics as it relates specifically to the controversial issue of alimentation (providing food and nourishment) at the end of life. This analysis will be based, in part, on a historical case involving Margot Bentley (MB), an 82-year-old Canadian residing in a long term care facility in British Columbia (2). MB is living with and dying from the end stages of Alzheimer’s disease and in 2013 Margot, her family and the care facility she resides in were at the centre of a legal battle over the circumstances necessary to constitute an imposed duty on caregivers to provide the basic necessity of life (food). This case exposed a number of concerns: the questionable utility and limits of living wills, surrogacy decision making, the actual meaning of implied consent, and what exactly constitutes medical treatment versus basic care. What is unique about this case is that it does show gaps in both ethical and judicial analysis which has resulted in a legal decision to provide a level of care the family believes would be untenable and lacking in dignity for MB.