According to the previous studies, dehydration and malnutrition are two major causes of death among people with dementia. Feeding difficulty is associated with malnutrition among people with dementia. The most frequent feeding difficulty as well as a formidable challenge to family caregivers is refusing to eat. People with dementia have difficulty in expressing their needs due to cognitive impairment. Caregivers could not recognize whether their refusal to eat is a wish to die or the result of the brain lesion of dementia with difficulty in taking food. Caregivers struggle with keeping people with dementia alive by forcing to eat or respecting their wishes for giving up feeding. Nursing staff also face the same ethical issues. The purpose of this article is to discuss the ethical and practical issues in food refusal of people with dementia.