Although most health care professionals accept the first explanation, there are some who sympathize with the latter. The majority who believe these measures to be medical treatment point out that other kinds of simple basic human needs (such as air) may be provided medically, if the patient is incapable of acquiring it without medical assistance. When this occurs, we see it as medical treatment. Thus a gastrostomy feeding tube is no more ordinary than intubation and mechanical ventilation. They emphasize that categorization of feeding tubes as "medical treatment" does not dictate what decision is made about them, but only how the decision is made. In some cases, enteral feeds preserve the patient’s life and help maintain an acceptable quality of life for a patient who is capable of sensing hunger. Such treatment is therefore appropriate and should be continued. In other cases however, the patient is so severely impaired neurologically, that (s)he is unaware of anything (as in PVS). .Sometimes a patient is clearly dying and the nutrition/hydration actually increase the suffering because of abdominal bloating or increased respiratory tract secretions.
For the patient who is permanently unconscious and beyond sensing hunger or thirst, it makes no sense to attribute such feelings to them, and the use of such language is clearly misplaced. Similarly, the administration of a treatment modality that increases suffering in a dying patient is medically incoherent and cruel.
The New York Health Care Proxy Law takes account of the societal difference of opinion about hydration and nutrition. Although a health care agent is generally empowered to make all decisions the patient could have made, in the case of the withholding or withdrawal of artificial hydration or nutrition, if the patient's wishes "are not reasonably known and cannot with reasonable diligence be ascertained", the law provides that "the agent shall not have authority to make decisions regarding these measures". It is unclear from this what documentation may be required regarding the agent's knowledge. Some institutions may interpret the law more narrowly than others. It is therefore wise to advise patients (who may want their agent to prevent or discontinue these measures) to specifically authorize their agent to withhold or withdraw artificial nutrition or hydration (on the proxy form) or to at least state that his or her agent "knows" his or her wishes in that regard.