Clinical Ethics and Nutrition Support Practice: Implications for Practice Change and Curriculum Development

Abstract

Clinical ethics awareness involving nutrition support has increased during the past 4 decades because of media attention and public discussion of several landmark cases, including Karen Ann Quinlan, Nancy Beth Cruzan, and Theresa Marie Schiavo, and the results of subsequent court decisions. 1 Schwartz D.B. Ethical considerations in the critically ill patient. in: Cresci G. Nutritional Therapy for the Critically Ill Patient: A Guide to Practice. 2nd ed. Taylor & Francis, Boca Raton, FL2015: 635-652 Crossref Google Scholar Yet decisions to start or stop nutrition support for specific individuals remain challenging. Withholding or withdrawing nutrition support is appropriate if the risks and burdens outweigh the potential benefits as perceived by the informed individual, family, or surrogate decision maker. Despite advancements in the field of nutrition support practice, a practice gap remains between appropriate use of nutrition support and other advanced life-sustaining treatments, such as mechanical ventilation and cardiopulmonary resuscitation, based on the individual’s wishes. 2 Geppert C.M.A. Barrocas A. Schwartz D.B. Ethics and law. in: Mueller C. McClave S.A. Schwartz D.B. Kovacevich D. Miller S.J. The A.S.P.E.N. Adult Nutrition Support Core Curriculum. 2nd ed. American Society for Parenteral and Enteral Nutrition, Springfield, MD2012: 656-676 Google Scholar , 3 Raijmakers N.J.H. van Zuylen L. Costantini M. et al. on behalf of OPCARE9Artificial nutrition and hydration in the last week of life in cancer patients. A systematic literature review of practices and effects. Ann Oncol. 2011; 22: 1478-1486 Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar , 4 Teno J.M. Gozalo P.L. Bynum J.P.W. et al. Change in end-of-life care for beneficiaries. JAMA. 2013; 309: 470-477 Crossref PubMed Scopus (753) Google Scholar , 5 Schwartz D.B. Barrocas A. Wesley J.R. et al. A.S.P.E.N. Special report: Gastrostomy tube placement in patients with advanced dementia or near end of life. Nutr Clinc Pract. 2014; 29: 829-840 Crossref PubMed Scopus (35) Google Scholar , 6 Institute of Medicine. Dying in America Improving Quality and Honoring Individual Preferences Near the End of Life, Key Findings and Recommendations. https://iom.nationalacademies.org/∼/media/Files/Report%20Files/2014/EOL/Key%20Findings%20and%20Recommendations.pdf. Published 2014. Accessed October 26, 2015. Google Scholar