Ethical Issues in Artificial Nutrition and Hydration: A Review

Abstract

Healthcare professionals often face clinical and ethical challenges when charged with making decisions related to provision or lack of provision of artificial nutrition and hydration. The intent of this review is to supply a framework of clinical practices, ethical principles, legal precedents, and professional guidelines that will impart information and can assist decision making regarding artificial nutrition and hydration. Comprehensive understanding of the theory and practice of informed consent for competent adults, decisionally incompetent adults, and minors is necessary for making valid clinical judgments and for guiding patients and their families or surrogates in choosing options related to initiating, withholding, or withdrawing artificial nutrition and hydration. The framework offered in this review can serve as a basis for evaluation of appropriateness of artificial nutrition and hydration in 3 common conditions in which decision making is particularly challenging: terminal illness, advanced dementia, and a persistent vegetative state. The framework facilitates guidance for institutional policy makers and individual nutrition support professionals dealing with situations in which personal values often create ethical dilemmas related to artificial nutrition and hydration and its utility.

ESPEN guidelines on nutrition in dementia

“…Further studies are needed on this topic, though they are difficult to conceive and to conduct due to ethical considerations [232] . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 1...…”

Feeding and hydration in terminal stage patients

“…As an extensive paper concludes [23] individuals often make medical choices based on their personal values, but clinicians and patients need guidelines to determine choices, including those related to use of feeding and hydration. But, from a practical point of view, we have seen that there are many open questions in relation to this topic, and, as it frequently occurs in medicine, solutions must be adopted on an individual basis.…”

Nutrition et hydratation en fin de vie : une mise en œuvre pas toujours bientraitante

“…C'est avec ces trois principes en tête que l'on peut analyser chaque situation difficile concernant des décisions de mise en oeuvre ou de non mise en oeuvre de techniques de NHA en fin de vie. [12,13].…”