The decision to terminate enteral feeding in a patient in a persistent vegetative state whose wishes have been made known through an advance directive is based on the ethical principle of

• A. Justice
• B. Autonomy
• C. Beneficence
• D. Nonmalfeasance

Answer: (B)

Respect for autonomy guides decisions when a patient has clearly expressed their wishes through an advance directive. In a persistent vegetative state, if the patient’s directive specifies not to pursue life-sustaining measures such as enteral feeding, clinicians should honor that choice because autonomy recognizes the right of individuals to determine what happens to their own bodies, even when they cannot communicate at the moment. This respects the patient’s values and preferences and allows their previously stated wishes to prevail, even if continuing feeding might seem to benefit in a different way. Beneficence aims to act for the patient’s good, but autonomy takes precedence when there is a clear directive. Nonmaleficence concerns avoiding harm, yet honoring the directive aligns care with what the patient has chosen as acceptable harm or burdens. Justice relates to fairness and resource distribution, which is not the central issue in this scenario.