The last two decades have been witness to considerable progress in the administration of artificial nutrition and hydration (ANH). This can be used to sustain life in various patient groups that would have previously succumbed to the effects of malnutrition. The complexity of these clinical cases often causes healthcare professionals great anxiety, as the decision to initiate or withdraw ANH has significant emotional, ethical and resource implications. These difficult decisions require considerable deliberation, balancing the judgements and values of patients, their families and carers, and even the cultural beliefs of society at large.