Appropriate Use of Artificial Nutrition and Hydration — Fundamental Principles and Recommendations

Casarett, David; Kapo, Jennifer; Caplan, Arthur L.

doi:10.1056/nejmsb052907

Cited by 163 publications

(85 citation statements)

References 59 publications

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“…A few analyses attempted to integrate these new data with the accepted ethics teachings about ANH. 37 These developments would have provided further support for Mr. Tyler's family's decision to refuse tube feeding.…”

Section: Late 1990s: Empirical Datamentioning

confidence: 99%

Artificial Nutrition and Hydration: The Evolution of Ethics, Evidence, and Policy

Brody

Hermer

Scott³

et al. 2011

J GEN INTERN MED

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Section: Late 1990s: Empirical Datamentioning

confidence: 99%

Artificial Nutrition and Hydration: The Evolution of Ethics, Evidence, and Policy

Brody

Hermer

Scott³

et al. 2011

J GEN INTERN MED

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“…47 The application of a "reasonable-person" standard would suggest that a large majority of people would not want to be kept alive in a persistent vegetative state via any means, including medically provided fluids and nutrition, and that surrogate decision-makers should, therefore, be permitted to forgo such interventions on their behalf. [48][49][50] It would be a form of age discrimination to impose on children the burdens and quality of life rejected by the majority of adults merely because they had not achieved legally independent status before their catastrophic injury.…”

Section: Situations In Which the Burdens Of Treatment Outweigh The Bementioning

confidence: 99%

Forgoing Medically Provided Nutrition and Hydration in Children

Diekema¹,

Botkin²

2009

Pediatrics

132

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There is broad consensus that withholding or withdrawing medical interventions is morally permissible when requested by competent patients or, in the case of patients without decision-making capacity, when the interventions no longer confer a benefit to the patient or when the burdens associated with the interventions outweigh the benefits received. The withdrawal or withholding of measures such as attempted resuscitation, ventilators, and critical care medications is common in the terminal care of adults and children. In the case of adults, a consensus has emerged in law and ethics that the medical administration of fluid and nutrition is not fundamentally different from other medical interventions such as use of ventilators; therefore, it can be forgone or withdrawn when a competent adult or legally authorized surrogate requests withdrawal or when the intervention no longer provides a net benefit to the patient. In pediatrics, forgoing or withdrawing medically administered fluids and nutrition has been more controversial because of the inability of children to make autonomous decisions and the emotional power of feeding as a basic element of the care of children. This statement reviews the medical, ethical, and legal issues relevant to the withholding or withdrawing of medically provided fluids and nutrition in children. The American Academy of Pediatrics concludes that the withdrawal of medically administered fluids and nutrition for pediatric patients is ethically acceptable in limited circumstances. Ethics consultation is strongly recommended when particularly difficult or controversial decisions are being considered.

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“…7 However, over time small studies have shown that PEG placement does not improve the risk of aspiration pneumonia in patients with advanced dementia over oral feeding. [8][9][10][11] Adjusting the consistency of food and liquids can reduce the risk of aspiration and discomfort. 2 Additionally, assistance with feeding by soliciting the help of a family member, caregiver, or nursing aide can improve oral intake.…”

Section: Discussionmentioning

confidence: 99%

Revisiting the Use of Percutaneous Endoscopic Gastrostomy Tubes in Patients with Advanced Dementia

Shaikh¹,

Hamilton²,

Bharadwaj

et al. 2009

Palliat�Care

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Mr. Smith is an 85-year-old nursing home patient who has suffered from dementia for the past eight years. He has been bed bound and uncommunicative for the last six months. He was admitted with aspiration pneumonia three times in the past year. Over the last few months he has lost weight due to poor dietary intake and has developed a decubitus ulcer. Mr. Smith's family inquires about the advantages and disadvantages of the placement of a percutaneous endoscopic gastrostomy (PEG) tube to help improve his weight loss.

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Appropriate Use of Artificial Nutrition and Hydration — Fundamental Principles and Recommendations

Cited by 163 publications

References 59 publications

Artificial Nutrition and Hydration: The Evolution of Ethics, Evidence, and Policy

Artificial Nutrition and Hydration: The Evolution of Ethics, Evidence, and Policy

Forgoing Medically Provided Nutrition and Hydration in Children

Revisiting the Use of Percutaneous Endoscopic Gastrostomy Tubes in Patients with Advanced Dementia

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