Ethics and artificial nutrition towards the end of life

Jones, Barry

doi:10.7861/clinmedicine.10-6-607

Cited by 10 publications

(6 citation statements)

References 12 publications

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“…El tema de la alimentación y su continuidad, y los posibles cambios en los pacientes crónicos y terminales, con todos los posibles factores propios de cada caso, han sido y son motivo de discusión ética local y global [1][2][3]5,12 .…”

Section: Discussionunclassified

“…Cada vez se cuestiona con mayor frecuencia la práctica de la gastrostomía en pacientes que se encuentran en situaciones clínicas limítrofes, en las cuales el beneficio puede ser limitado o nulo [1][2][3][4][5][6][7][8][9] ; además, los médicos subvaloran su riesgo general 10,11 y, realmente, no se previenen las complicaciones que se quieren evitar, como malnutrición o neumonía aspirativa, debido a que la alimentación es gástrica y, por lo tanto, está sujeta a la regulación de la fisiología digestiva 6,12 .…”

Section: Introductionunclassified

See 1 more Smart Citation

Futilidad en cirugía: el caso de la gastrostomía

Torregrosa¹,

Gómez²,

Franco³

et al. 2020

Rev Colomb Cir

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Introducción. La nutrición se ha considerado tradicionalmente una necesidad básica y el garantizarla se ha asumido como una responsabilidad médica. Se cuestiona la utilización de procedimientos que permitan la nutrición artificial en situaciones clínicas limítrofes, en las cuales su beneficio puede ser limitado o nulo. En el presente estudio se busca determinar el éxito de un procedimiento quirúrgico, la gastrostomía, desde la perspectiva del beneficio para el paciente y, así, aproximarse a una definición de gastrostomía fútil. Métodos. Se llevó a cabo un estudio observacional, retrospectivo y analítico, basado en la revisión de las historias clínicas de los pacientes sometidos a gastrostomía abierta o endoscópica en el Hospital Universitario San Ignacio. El grupo de investigadores principales analizaron los datos para determinar si las gastrostomías practicadas fueron fútiles o no lo fueron. Resultados. Se incluyeron 145 pacientes tratados durante el periodo del 2015 al 2018 y en el 53 % de los cuales se cumplieron los criterios para considerar el procedimiento como fútil. Los procedimientos –108 endoscópicos y 37 abiertos–fueron practicados principalmente en pacientes con neoplasias de cabeza y cuello, y enfermedades neurológicas. Si bien no hubo mortalidad asociada con el procedimiento, 26 de los pacientes fallecieron en los primeros 15 días después de la intervención. Discusión. El determinar en qué condiciones se debe considerar la gastrostomía una intervención realmente beneficiosa es un desafío. Es necesario incorporar un análisis ético, antes de ofrecer este procedimiento, con el fin de minimizar las gastrostomías innecesarias que actualmente constituyen un problema global.

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Section: Discussionunclassified

Section: Introductionunclassified

Futilidad en cirugía: el caso de la gastrostomía

Torregrosa¹,

Gómez²,

Franco³

et al. 2020

Rev Colomb Cir

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“…Our ndings support previous studies that showed the di culty of provision of ANH to the end-of-life patients. 12,13 Contradictory perspectives consider the ANH either a kind of fundamental care for anyone or medical therapy without clear indications. 3,14 The preference of LST and ANH might be attributable to culture, religion, tradition, value and beliefs, administrative guidelines, and the doctor-family-patient relationships.…”

Section: Strengthsmentioning

confidence: 99%

“…1,[15][16][17] Arti cial feeding plays a role in bridging the gap between coma-inducing occurrence and the realization that recovery is either imminent or exceedingly unlikely. 13 Late-stage dementia is characterized by a loss of ability and desire to eat. Relatives may experience emotional sufferings when the patients reduce oral intake.…”

Section: Strengthsmentioning

confidence: 99%

Urban people’s preferences for life-sustaining treatment or artificial nutrition and hydration in advance decisions

Lin

Yang

et al. 2023

Preprint

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Objectives This study investigated the preferences of AD, consistency, and differences in LST and ANH preferences, and factors affecting LST and ANH selection among urban residents.Research Methodology: A retrospective observational design and Convenience sampling were utilized in this study. Data of 2337 individuals with legal ability who were at least 20 years old and attended the ACP consultations from January 5 to January 6, 2020, were retrieved from the electronic records.Setting: Taiwan's Patient Right to Autonomy Act was put into effects in 2019 and allowed the signing of advance decisions (AD) through advance care planning (ACP). Withhold and withdrawal from life-sustaining treatment (LST) or artificial nutrition and hydration (ANH) treatment are now allowed for anyone to be in a condition of irreversible coma, vegetative state, severe dementia, or unbearable pain.Main Outcome Measures: Preferences of life-sustaining treatment and artificial nutrition/hydration, clinical conditions, differences from participants' preferences, and factors associated with preferenceResults High consistency was found in the willingness of refusing LST and ANH which differed significantly between the terminal diseases and extremely severe dementia. Besides, ANH was widely accepted as a time-limited treatment as well as authorizing health care agent to make decisions on behalf of the patients.Conclusion Significant differences were found in gender, age, and consultation intention in not wishing the family to take responsibility in making decisions. Influential factors involved cultural impacts and demographics.

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“…Artificial nutrition in the last stages of dementia can be seen as resulting in more harm than benefit. Instead, taking small amounts of food and fluid by mouth could be advised to maintain comfort, as this will outweigh the risks of aspiration (Jones 2010). Quality of life and death, rather than prolonging life, should be the priority when caring for residents with advanced dementia during the last stages of the illness.…”

Section: Artificial Nutritionmentioning

confidence: 99%

Methods for managing residents with dysphagia

Rudakiewicz¹

2015

Nursing Older People

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Nurses working in nursing homes will care for residents who have dysphagia, or difficulty swallowing, on a regular basis. Clear, evidence-based guidelines are necessary for all staff to be able to meet the needs of these residents safely and efficiently. A multidisciplinary approach is important to ensure accurate assessment, devise appropriate care and achieve specific goals. Equipment such as valved beakers, rimmed plates and non-slip mats will help maintain safety during mealtimes. Prescription items, such as fluid thickeners and anticholinergic medication, help to manage the condition and provide comfort during mealtimes and in between. Robust education and training should be in place for all nursing and care staff who care for residents with the condition.

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Ethics and artificial nutrition towards the end of life

Cited by 10 publications

References 12 publications

Futilidad en cirugía: el caso de la gastrostomía

Futilidad en cirugía: el caso de la gastrostomía

Urban people’s preferences for life-sustaining treatment or artificial nutrition and hydration in advance decisions

Methods for managing residents with dysphagia

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