Ethical Reasoning Concerning the Feeding of Severely Demented Patients: an International Perspective

Abstract

Structured interviews were held with 149 registered nurses in seven countries in America, Asia, Australia and Europe concerning the feeding of severely demented patients who do not accept food. The most common reasons for nurses being willing to change their decision to feed or not to feed were an order from the medical head, a request from the patient's husband and/or the staff meeting. There was a connection between the willingness to feed and the ranking of ethical principles. Nurses who were most prone to feed the patient most often gave a high rank to the ethical principle of sanctity of life, while those who primarily chose not to feed the patient gave a high rank to the ethical principle of autonomy. All nurses stressed the ethical principle of beneficence.

Ethical Issues in the Feeding of Patients Suffering from Dementia: a focus group study of hospital staff responses to conflicting principles

“…Given the complexity of the focus, this seemed the right instrument for data collection. This was also intended to complement other research, such as that of Norberg et al, 12,13 which used oneto-one interviews. The study involved nursing and health care assistant staff caring for elderly patients in three wards of one psychiatric hospital in the English Midlands.…”

“…Norberg et al 12 found that autonomy and beneficence were prominent in the principles cited by Swedish informants. Norberg et al 13 found that an international sample of nurses used a range of ethical principles to guide them in deciding when feeding efforts should be terminated, with western informants more likely to choose not to feed and more likely to cite autonomy in this connection than informants from other parts of the world.…”

Meeting the End of Life Needs of Older Adults with Intellectual Disabilities

“…Feeding difficulties and challenges experienced as part of end-stage dementia care by persons with intellectual disability mirror those difficulties described in the generic care literature in persons with Alzheimer's dementia (Norberg et al, 1994;Biernacki & Barratt 2001;. Lack of ability to self-feed, the difficulty of holding food in one's own mouth, chewing and swallowing concerns, agitation and distress, spitting, and food inhalation/aspiration all culminate in stress for the person, the family and staff (McCarron et al, 2003).…”

Retired Registered Nurses’ Stories About Being in Ethically Difficult Care Situations

“…[9][10][11][12] Another kind of cultural difference is constituted by variations within a country between health care specialties. 13 Since the 1940s, there have been great changes in nursing care in Sweden.…”