ESPEN guideline on ethical aspects of artificial nutrition and hydration

Druml, Christiane; Ballmer, Peter E.; Druml, Wilfred; Oehmichen, Frank; Shenkin, Alan; Singer, Pierre; Soeters, Peter B.; Weimann, Arved; Bischoff, Stephan C.

doi:10.1016/j.clnu.2016.02.006

Cited by 285 publications

(352 citation statements)

References 69 publications

Supporting

Mentioning

256

Contrasting

Unclassified

Order By: Relevance

“…Contudo, os problemas surgem quando isto não é possível ou a ingestão de nutrientes e líquidos é insuficiente. Dessa forma, cabe aos profissionais de saúde fornecer o tratamento adequado, incluindo a terapia de nutrição e hidratação 7 .…”

Section: Artigo De Revisão Resumounclassified

Consensos e dissensos na indicação e continuidade da terapia nutricional enteral nos cuidados paliativos de pacientes com doenças crônicas não transmissíveis

2017

View full text Add to dashboard Cite

RESUMOAs doenças crônicas não transmissíveis (DCNT) representam as principais causas de internações hospitalares, geram impactos socioeconômicos e comprometimento da qualidade de vida em virtude de suas sequelas e incapacidades, justificando a importância e necessidade crescente de associação dos cuidados paliativos ao tratamento curativo. Esta revisão narrativa visa apresentar os consensos e dissensos sobre a indicação e a continuidade da terapia nutricional enteral (TNE) nos cuidados paliativos de pacientes com DCNT. Embasou-se em publicações oficiais sobre o tema e 15 artigos divulgados nas bases de dados: LILACS, SciELO, PubMed, MEDLINE, Cochrane Library e Science Direct, entre os anos de 2005 e 2016. Os objetivos do suporte nutricional nos cuidados paliativos desses pacientes variam com a evolução da doença. O suplemento nutricional oral é indicado para complementar a ingestão alimentar oral insuficiente, reduzindo custos hospitalares e favorecendo melhoras clínicas e funcionais. Na ingestão alimentar menor do que 60% e sem previsão de evolução, é indicada a TNE dentro dos três primeiros dias, mas sua continuidade em doenças avançadas permanece controversa. Na fase terminal, prioriza-se o conforto, o alívio dos sintomas e não mais a adequação nutricional. Nessa fase, a nutrição e hidratação artificiais podem não ser benéficas. Dessa forma, a nutrição nos cuidados paliativos é individualizada, depende do estágio da doença e visa promover a qualidade de vida. As tomadas de decisão devem envolver a vontade do paciente e de seus familiares, considerando os princípios de autonomia, beneficência, não maleficência e justiça.Palavras-chave: cuidados paliativos; doença crônica; terapia nutricional. ABSTRACTNon-communicable diseases (NCD) are the leading cause of hospital admissions, result in socioeconomic impacts and prejudice on quality of life due to after-effects and disabilities, justifying the importance and the increasing need to associate palliative care with curative treatment. This narrative review aims to introduce agreements and disagreements on indication and continuity concerning enteral nutritional therapy (ENT) in palliative care patients with NCD. This paper was based on official publications related to the topic and 15 articles found on LILACS, SciELO, PubMed, MEDLINE, Cochrane Library and Science Direct databases, between the years 2005 and 2016. In these patients, the objective of nutritional support in palliative care varies according to the evolution of the disease. Oral nutritional supplement is indicated to supplement insufficient oral food intake, reducing hospital costs and favoring clinical and functional improvements. When food intake is less than 60% and without evolution prospects, ENT is indicated within the first 3 days, but withholding and withdrawing it in advanced diseases remains controversial. In terminal phase, comfort and relief of symptoms are the priority instead of nutritional adequacy. On this stage, artificial nutrition and hydration may not be beneficial. Therefore, nutri...

show abstract

Section: Artigo De Revisão Resumounclassified

Consensos e dissensos na indicação e continuidade da terapia nutricional enteral nos cuidados paliativos de pacientes com doenças crônicas não transmissíveis

2017

View full text Add to dashboard Cite

show abstract

“…Prolonging of life may never turn into prolonging of the dying phase' [19] (p. 547). '11: Every individual is entitled to obtain the best care available.…”

Section: We All Need Food and Water To Survivementioning

confidence: 99%

“…The guidelines provided by The European Society for Clinical Nutrition and Metabolism (ESPEN), an international multidisciplinary working group, include at least 10 statements which are highly relevant to the terminal patient [19].…”

Section: We All Need Food and Water To Survivementioning

confidence: 99%

“…Examples of inclusions are: One position statement from the American Association of Feline Practitioners (AAFP) sums up the end of life issues succinctly for one species of pet animals in the United States [18]. One International collaborative guide, on artificial nutrition and hydration guidelines for those attending to patients at the end of their lives, emphasizes that the dying process should not be prolonged [19]. On the other hand, one white paper from the European association for palliative care (EAPC) states that the provision of euthanasia and PAS should not be included into the practice of palliative care [15].…”

Section: Exclusion/inclusion Criteriamentioning

confidence: 99%

See 1 more Smart Citation

Treatment, Palliative Care or Euthanasia? Comparing End of Life Issues in Human and Veterinary Medicine

Eyre-Pugh¹,

Yeates²

2017

Preprint

View full text Add to dashboard Cite

Not a lot is known about either death or the dying process. Politicians and the medical profession in the UK tend to shy away from interfering with it by not allowing euthanasia as an end of life option for the patient. This is the first paper in a series of two, comparing the situation in human medicine and veterinary medicine, in which euthanasia is well practiced for relieving suffering at the end of life. This first part takes the form of a literature review including best practice around end of life care, its deficiencies and the need for assisted dying. Veterinary surgeons are well trained in the ethics of euthanasia and put it to good use in the best interest of their animal patients. In countries which have legalized physician assisted suicide for the terminally ill reporting indicates that it works well, without increases in involuntary euthanasia and most importantly without intimidation of the vulnerable. However, there is still an ever increasing tendency to overuse sedation and opioids at the end of life, which merits further investigation. With advances in medical science able to significantly prolong the dying process, patient autonomy demands a review of the law in the UK.

show abstract

“…There’s no shortage of literature and official guidance on when tube feeding or its withdrawal is most clinically appropriate or effective1234 or most legally56 or ethically789 permissible.…”

mentioning

confidence: 99%

David Oliver: Tube feeding and deteriorating patients—guidelines can take us only so far

Oliver

2018

BMJ

View full text Add to dashboard Cite

ESPEN guideline on ethical aspects of artificial nutrition and hydration

Cited by 285 publications

References 69 publications

Consensos e dissensos na indicação e continuidade da terapia nutricional enteral nos cuidados paliativos de pacientes com doenças crônicas não transmissíveis

Consensos e dissensos na indicação e continuidade da terapia nutricional enteral nos cuidados paliativos de pacientes com doenças crônicas não transmissíveis

Treatment, Palliative Care or Euthanasia? Comparing End of Life Issues in Human and Veterinary Medicine

David Oliver: Tube feeding and deteriorating patients—guidelines can take us only so far

Contact Info

Product

Resources

About