The Ethics of Withdrawing Artificial Food and Fluid from Terminally Ill Patients: an end-of-life dilemma for Japanese nurses and families

Abstract

End-of-life issues have become an urgent problem in Japan, where people are among the longest lived in the world and most of them die while connected to high-technology medical equipment. This study examines a sensitive end-of-life ethical issue that concerns patients, families and nurses: the withdrawal of artificial food and fluid from terminally ill patients. A sample of 160 Japanese nurses, who completed a questionnaire that included forced-choice and open-ended questions, supported this act under only two specific conditions: if the patient requested it, and if it relieved the patient's suffering. They considered that the doctor's orders, the family's request, or the patient's advanced age did not ethically justify this act. A small number of people who had recently lost a relative took part in semistructured interviews focusing on their experiences of their terminally ill relatives being given artificial food and fluid. Ethical, social and cultural factors surrounding this issue are discussed.

A Pilot Study of Selected Japanese Nurses’ Ideas on Patient Advocacy

“…[15][16][17][18] With these socially contingent ethics problems in mind, they perceive a rights based ethics as a means to solving these problems. If others, such as families and physicians, view these two approaches as mutually exclusive, then these nurses go against the cultural and morally defined norms.…”

Attitudes to End-of-Life Decisions in Paediatric Intensive Care

“…[35][36][37] In another study, nurses supported the withdrawal of artificial food and fluid if it would relieve the patient's suffering, as the American Nurses Association and the American Academy of Pediatrics have recommended. 38 In the current study, the intensive care nurses had negative attitudes towards limiting all modes of treatment, including artificial nutrition and hydration. This result suggests that the nurses might violate their duties imposed by the principles of 'do not harm' and 'justice'.…”

Nurses’ attitudes towards artificial food or fluid administration in patients with dementia and in terminally ill patients: a review of the literature

“…Our search strategy yielded 15 appropriate publications containing 14 separate studies 24 28 29 33 – 44. The articles of Wurzbach37 38 represent two publications derived from the same study; therefore, we considered them as one study.…”

“…Five studies were classified as being qualitative,24 28 35 37 38 41 and eight were classified as being quantitative 33 34 36 39 40 42 – 44. We also identified one mixed-method study that used both qualitative and quantitative approaches 29. Six studies dealt with demented patient populations,28 36 39 41 42 44 six studies concentrated on terminally ill patients,24 29 33 34 37 38 40 and two studies focused on both populations 35 43…”

“…Nurses often initiate the decision-making process by informing family members and physicians about a patient’s condition 28. Furthermore, nurses try to influence physicians’ decisions by questioning them and expressing concerns 26 28 29. Moreover, of all caregivers, nurses have the closest and most trusting relationship with patients and their families during the entire care process at the end of life 28 30 31…”