Table 1.

Factors Encouraging the Use of ANH in Practice

Involved party	Factors favoring ANH
Family members	Unwillingness to accept terminal prognosis Belief in cruelty of dying process if ANH not administered Need to demand interventions to avoid guilt
Physicians	Lack of familiarity with palliative care techniques and evidence Length of time required to educate families on true facts of ANH Reimbursement for insertion of PEG tube, etc. Desire to avoid controversial discussions Fears of litigation
Administrators	Reimbursement for tube feedings, etc. Fear of regulatory sanctions if ANH not administered (nursing homes) Extra time and staff needed to assist with oral feedings in weakened or demented patients Fears of litigation