This article will discuss this common occurrence, the importance of discussing end-of-life healthcare issues with patients and family members while honoring patients' wishes, strategies to prevent conflict, and the rd's role in ethical decision making in the context of enteral and parenteral nutrition. A number of high-profile legal cases since the 1980s have involved persons receiving medically assisted nutrition and hydration (food and water): claire conroy, paul brophy, nancy cruzan, hugh. A case illustrating the legal and ethical complications of withholding nutrition and hydration from a patient in a vegetative state led to the passage of the patient self-determination act patient self-determination act. 3 than curative such treatment includes artificial nutrition and hydration and continuous repositioning of the body these treatments may be initiated in the hospital, but. Also see the separate article coma previously, the term persistent vegetative state (pvs) was used to describe all patients with prolonged disorders of consciousness pvs has become marked by ethical and medical dilemmas, often, if not always, requiring legal assistance there are now several cases.
Other viable alternative to maintain adequate nutrition and/or hydration is possible and the use of the feeding tube is consistent with the clinical objective of trying to maintain or improve nutritional and hydration parameters. Nutrition or hydration comatose patients or those in a persistent vegeta- there is agreement that the ethical and societal issues involved are complex. Also in agreement on allowing withdrawal of nutrition and hydration are the report of the president's commission for the study of ethical problems in medicine and biomedical and be- havioral research, deciding to forego life-sustaining treatment: a report on the ethical.
Ethical issues related to death and dying we focus on ethical considerations of subjects that include the benefits and drawbacks of various types of modern treatment, ending life. Ethical issues in artificial nutrition 67 the objective of this study was to elucidate the ethical dilemmas regarding withholding or withdrawal of anh. Friends and family should understand that it is both legal and ethical to withhold artificial nutrition and hydration in cases where the patient has properly refused them furthermore, families must also realize that once a peg has been placed, it is both legal and ethical to withdraw the tube, should the patient's suffering become extreme.
In the last century, with the advent of plastic tubing, 2 new ethical issues have been raised regarding nutrition and hydration by performing fairly simple procedures, artificial nutrition and hydration (an&h) may be provided to almost all patients, including those unable to swallow. Is it ethical to withdraw a patient from artificial nutrition and hydration required to sustain the patient's life may be short term or long term considered a basic human need. The ethical and religious directives state, there should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.
The ethics of artificial nutrition and hydration medical ethics, at least as practiced at the bedside in the form of clinical ethics, properly starts with medical science and then moves to human behavior, spirituality, health law, and finally moral argumentation. For comatose patients and patients in a persistent vegetative state artificial nutrition is a necessary support to bridge the time until either recovery is imminent or improbable. Or during the dying process after withdrawal of artificial hydration and nutrition , the latter on the grounds that these patients do not experience suffering from hunger or thirst [16.
For comatose patients and patients in a persistent vegetative state artificial nutrition is a necessary support to bridge the time until either recovery is imminent or improbable at that moment artificial nutrition no longer contributes to the life of the patient and should be ceased. Ethical issues near the end of life: this article features information on life support and raises questions about the many ethical issues surrounding it for healthcare providers, please also take our advanced cardiac life support overview quiz which reviews all the advanced topics. Nutrition and hydration are life-sustaining medical therapies that, like other medical therapies, can be legally initiated or ceased27 the american dietetic association's position paper on providing food and hydration to the terminally ill states, the patient's expressed desire is the primary guide for determining the extent of. Making decisions with families at the end of life the physician must discuss end-of-life issues with the family members of these patients the legal, ethical, and nutrition and hydration17.
In the last century, with the advent of plastic tubing, new ethical issues have been raised regarding nutrition and hydration of patients in comatose, or that of persistent vegetative states. The question of whether to insert a feeding tube is one of the most difficult issues in the management of severely ill patients we cannot expect a simple answer to this quandary. The same questions regarding patients with a minimal level of consciousness, termed glimmering awareness, could create greater legal and ethical difficulty.