Role of the Nutrition Support Clinician on a Hospital Bioethics Committee

Abstract

Hospital bioethics committees comprise a diverse group of healthcare professionals to deal with ethical issues within the institution that arise during patient care. The nutrition support clinicians (NSCs) have an important role on a bioethics committee because of their knowledge and expertise of different nutrition routes and the benefits vs burdens and risks of these modalities, both enteral and parenteral nutrition. Ethics expertise is built on an understanding of ethical principles, when applied in clinical ethics, using critical thinking to prevent ethical dilemmas and to assist in healthcare decision making with a focus on patient-centered care. The NSCs have the opportunity to address ethics during direct patient care with their participation in the intensive care unit interprofessional rounds, family meetings, and surrogate meetings. Evident in ethical dilemmas is often the lack of advance care planning by patients and their family members concerning healthcare wishes for when the individual is unable to communicate their preferences for lifesustaining therapies, including nutrition support. NSCs, as hospital bioethics committee members, are able to support the initiative of National Healthcare Decisions Day to help educate other healthcare clinicians and the public about the importance of advance care planning with communication of healthcare wishes and completion of an advance directive. Components addressed in the article are incorporated into a comprehensive ethics case study, highlighting the role of NSCs. (Nutr Clin Pract. 2019;34:869-880) From the

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

“…Resources are available to assist clinicians in learning about different cultures and religions and to enhance awareness of how these can impact ethical decision-making. 19,[21][22][23][24][25][26][27] Consideration of cultural values and religious beliefs impacted with COVID-19 may have increased complications around EOL decisions and AANH. The limited presence of family members and faith leaders in the hospital setting may lead to patients feeling isolated at EOL and can impact healthcare decision-making around AANH.…”

“…The limited presence of family members and faith leaders in the hospital setting may lead to patients feeling isolated at EOL and can impact healthcare decision-making around AANH. 19,21,28 Cultural values and religious beliefs include a wide range of implications that may both be new to some clinicians/teams and are imperative to gain knowledge so as to incorporate and improve decisions regarding AANH and interventions during care. 19 Patients and family members may expect that the individual should at all times receive food and fluids, even if by an artificial route, as standard of care for survival.…”

“…Consultation for cultural values and religious belief support, an interpreter, visual information, or institutionbased bioethics committee consults may additionally be necessary/offered. 19,21,22…”

“…Several interdisciplinary teams and committees are involved in preventing and resolving ethical dilemmas, including unit rounds, care teams, palliative care teams, bioethics committees, and surrogate committees. 21,29,30 Hospital bioethics committee members include a diverse group of healthcare professionals and a community member to deal with ethical issues within the institution. The bioethics committee is responsible for consults that occur during patient care.…”

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

“…A Bioethics Committee, including an RDN as a member, is highly valuable. 5 The RDNs often have specific knowledge regarding the individual's preference because they discuss feeding issues with the individual and family.…”