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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We found the study by Pasman and colleagues,¹ which evaluated discomfort in patients with severe dementia, in whom artificial nutrition and hydration (ANH) was forgone, to be problematic. The authors provide evidence, using the Discomfort Scale–Dementia of Alzheimer Type (DS-DAT), suggesting that withholding tube feeding in patients with end-stage dementia carries no undue burden of physical discomfort. However, the ability to recognize discomfort in such patients is very limited, and as such, raises serious question as to the validity of the findings.

The DS-DAT used by Pasman and investigators¹ may not be valid for patients who are not awake and should ideally be scored by someone unfamiliar with the patient. Furthermore, the DS-DAT scores reported in this study contain wide variability, reflecting substantial individual differences within the patient cohort. It is precisely because of these limitations and the variability among individual patients that the general conclusion is flawed.

When ANH . . . [Full Text of this Article]

AUTHOR INFORMATION
Greg F. Burke, MD; John M. Travaline, MD

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