Factors related to adult patient decision making about withholding or withdrawing nutrition and/or hydration.

End-of-life decisions that focus on withholding or withdrawing nutrition and/or hydration present difficult choices at particularly vulnerable times for patients and families. Clinical ethics studies published in the last twenty years provide insight about the decision making process that can be useful to all parties involved. The purpose of the systematic research review is to synthesize empirical data about patient/surrogate decision making related to withholding or withdrawing nutritional sustenance toward the end of life, and contextual factors that influence their decision making. Future topics for clinical ethics research and clinical practice implications are posed.