This chapter explores the complex ethical dimensions associated with artificial nutrition in intensive care settings, focusing on the intersection of patient autonomy, authenticity, and best interest. Against the backdrop of legal developments in Germany, including landmark rulings and legislative amendments, the discussion highlights the challenges in assessing the will of patients—whether current, previously expressed, or presumed—particularly in cases involving cognitive impairment or incapacity. The concept of authenticity is introduced as a critical yet underutilized ethical criterion, complementing the principle of autonomy by emphasizing the embodied, narrative, and context-sensitive nature of patient decisions. Furthermore, the paper scrutinizes the potential for medical overreach, surrogate bias, and utilitarian tendencies in care, advocating for a reconstructive clinical ethics approach. This includes narrative-based and participatory processes that respect the patient’s values while balancing the ethical implications of life-prolonging versus suffering-prolonging interventions. The paper concludes with a practical framework to support ethical decision-making in clinical settings, emphasizing the need for institutionalized ethics support.