Advancing Nutrition and Dietetics Practice: Dealing With Ethical Issues of Nutrition and Hydration

Schwartz, Denise B.; Posthauer, Mary Ellen; Maillet, Julie OʼSullivan

doi:10.1016/j.jand.2020.07.028

Cited by 15 publications

(15 citation statements)

References 25 publications

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“…The Ethics Work Group of the Spanish Society in Parenteral and Enteral Nutrition (SENPE) recently (2019) published a confirmation that the placement of tubes for nutrition in patients with advanced dementia was a futile treatment that only contributed to prolonged suffering and concluded that health care professionals should not make wide use of EN by tube [ 27 ]. Schwartz et al considered that EN by tube could improve quality of life, but that the benefits in the last days phase were limited and did not exceed the loads [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

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Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review

Sánchez-Sánchez

Ruano-Álvarez²,

Díaz-Jiménez

et al. 2021

Nutrients

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Nutritional management of patients under palliative care can lead to ethical issues, especially when Enteral Nutrition (EN) is prescribed by nasogastric tube (NGT). The aim of this review is to know the current status in the management of EN by NG tube in patients under palliative care, and its effect in their wellbeing and quality of life. The following databases were used: PubMed, Web of Science (WOS), Scopus, Scielo, Embase and Medline. After inclusion and exclusion criteria were applied, as well as different qualities screening, a total of three entries were used, published between 2015 and 2020. In total, 403 articles were identified initially, from which three were selected for this review. The use of NGT caused fewer diarrhea episodes and more restrictions than the group that did not use NG tubes. Furthermore, the use of tubes increased attendances to the emergency department, although there was no contrast between NGT and PEG devices. No statistical difference was found between use of tubes (NGT and PEG) or no use, with respect to the treatment of symptoms, level of comfort, and satisfaction at the end of life. Nevertheless, it improved hospital survival compared with other procedures, and differences were found in hospital stays in relation to the use of other probes or devices. Finally, there are not enough quality studies to provide evidence on improving the health status and quality of life of the use of EN through NGT in patients receiving palliative care. For this reason, decision making in this field must be carried out individually, weighing the benefits and damages that they can cause in the quality of life of the patients.

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Section: Discussionmentioning

confidence: 99%

“…Sometimes, it is the patients themselves who do not wish to receive EN by NG tube [ 28 ]. Therefore, it is necessary to make an individualized decision, even though no other contraindications may be found.…”

Section: Discussionmentioning

confidence: 99%

Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review

Sánchez-Sánchez

Ruano-Álvarez²,

Díaz-Jiménez

et al. 2021

Nutrients

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“…That is why, usage of AN may be justified in patients that receive palliative care, are undernourished, and have a reasonable life expectancy, if it would improve their quality of life [ 19 , 20 ]; but there are not enough good quality studies that help to provide recommendations about EN by nasogastric tube in patients that receive palliative care [ 21 ]. Occasionally, it is considered an unnecessary treatment that only contributes to extend suffering, and that this treatment should not be used [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Nurse and Nursing Students’ Opinions and Perceptions of Enteral Nutrition by Nasogastric Tube in Palliative Care

Sánchez-Sánchez¹,

Ramírez-Vargas²,

Peinado-Canas³

et al. 2021

Nutrients

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It is widely accepted that nursing staff play a key role in palliative care (PC). The use of Nasogastric tubes (NG tubes) for Enteral Nutrition (EN) administration is still controversial in patients who receive PC. The aim of this study was to describe nurses’ and nursing students´ opinions and perceptions about EN using NG tubes in adult patients in palliative care. To achieve this goal, a cross-sectional descriptive study was carried out. A self-administered, semi-structured questionnaire intended for nurses and nursing students was used. Data was descriptively and inferentially analyzed using a chi-square test to determine the differential frequency of responses. In addition, a multivariate logistic regression model was also conducted. A total of 511 participants completed the questionnaire. Among them, nursing staff represented 74.9% (n = 383) whereas nursing students were 25.1% (n = 128). When life expectancy was above six months, 90.0% (n = 460) reported that EN using NG should be implemented. In contrast, when life expectancy is less than a month, 57.5% (n = 294) discouraged it. Significant differences within groups were found when life expectancy was <1 month (p = 0.044). It was also found that 491 participants (96.1%) reported that patient´s autonomy must be carefully respected for deciding whether continuing EN by NG tube or not. Finally, it was concluded for both nurses and nursing students that life expectancy should be the mean reason for implementing and withdrawing EN by NG tube. Major differences were found regarding when it should be ceased, suggesting perceptions may change as nurses graduate and move into their professional roles.

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“…Essentially, clinical ethics is grounded in patient‐centered care with a goal to achieve healthcare that focuses on patients’ preferences for their own healthcare. Included in the goal is to use EBM that provides the most benefit with the least harm and is provided to all individuals equally 9 …”

Section: Ethical Decision‐making Backgroundmentioning

confidence: 99%

“…Included in the goal is to use EBM that provides the most benefit with the least harm and is provided to all individuals equally. 9 The 4 basic ethical principles are identified with the terms autonomy, beneficence, nonmaleficence, and justice. It is important for clinicians to be aware of these ethical principles and apply them in clinical practice.…”

Section: Bioethical Theorymentioning

confidence: 99%

Ethical Aspects of Artificially Administered Nutrition and Hydration: An ASPEN Position Paper

et al. 2021

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The American Society for Parenteral and Enteral Nutrition (ASPEN) Position Paper focus is on applying the 4 ethical principles for clinician's decision-making in the use of artificially administered nutrition and hydration (AANH) for adult and pediatric patients. These basic principles are (1) autonomy, respect the patient's healthcare preferences; (2) beneficence, provide healthcare in the best interest of the patient; (3) nonmaleficence, do no harm; and (4) justice, provide all individuals a fair and appropriate distribution of healthcare resources. Preventing and resolving ethical dilemmas is addressed, with an emphasis on a collaborative, interdisciplinary approach. Optimizing early communication and promoting advance care planning, involving completion of an advance directive, including designation of a surrogate decision-maker, are encouraged. Clinicians achieve respect for autonomy when they incorporate the patient, family, community, country, geographical, and presumed cultural values and religious belief considerations into ethical decision-making for adults and children with a shared decision-making process. These discussions should be guided by the 4 ethical principles. Hospital committees and teams, limited-time trials, clinician obligation with conflicts, and forgoing of AANH are addressed. Specific patient conditions are addressed because of the concern for potential ethical issues: coma, decreased consciousness, and dementia; advanced dementia; cancer; eating disorders; and end-stage disease/terminal illness. Incorporated in the Position Paper are ethical decisions during a pandemic and a legal summary involving ethical issues. International authors presented the similarities and differences within their own country or region and compared them with the US perspective.

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Advancing Nutrition and Dietetics Practice: Dealing With Ethical Issues of Nutrition and Hydration

Cited by 15 publications

References 25 publications

Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review

Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review

Nurse and Nursing Students’ Opinions and Perceptions of Enteral Nutrition by Nasogastric Tube in Palliative Care

Ethical Aspects of Artificially Administered Nutrition and Hydration: An ASPEN Position Paper

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