The Difficult Decision Not to Prescribe Artificial Nutrition by Health Professionals and Family: Bioethical Aspects

Abstract

IntroductionBioethics and nutrition are essential issues in end of life, advanced dementia, life-sustaining therapies, permanent vegetative status, and unacceptably minimal quality of life. Even though artificially administered nutrition (AAN), for this type of health condition, does not improve quality of life and extension of life, and there is evidence of complications (pulmonary and gastrointestinal), it has been used frequently. It had been easier considering cardiopulmonary resuscitation as an ineffective treatment than AAN for a healthy team and/or family. For this reason, many times, this issue has been forgotten.ObjectivesThis study aimed to discuss bioethical principles and AAN in the involved patients.DiscussionThe AAN has been an essential source of ethical concern and controversy. There is a conceptual doubt about AAN be or not be a medical treatment. It would be a form of nourishment, which constitutes primary care. These principles should be used to guide the decision-making of healthcare professionals in collaboration with patients and their surrogates.ConclusionsThis difficult decision about whether or not to prescribe AAN in patients with a poor prognosis and without benefits should be based on discussions with the bioethics committee, encouraging the use of advanced directives, education, and support for the patient, family, and health team, in addition to the establishment of effective protocols on the subject. All of this would benefit the most important person in this process, the patient.

Validación y resultados preliminares de un cuestionario a médicos acerca de los aspectos bioéticos relativos al uso de la alimentación enteral en pacientes con demencia

“…Se utilizaron los términos dementia, nutrition y bioethics, en inglés y en español, considerando un periodo desde el año 2000 hasta la actualidad. Se encontraron 8 artículos en PubMed, de los cuales se descartaron 6, por no tratar acerca de la temática de estudio, quedando seleccionados dos artículos (25,46). También se obtuvieron y seleccionaron 13 artículos acordes al tema en las revistas de bioética (47-59) (figura 1).…”

“…Esto ha llevado a considerar que la alimentación enteral constituye un tratamiento que podría suspenderse en caso de que los riesgos e inconvenientes excedan los beneficios (23,24,19). Pereira et al sostienen la importancia de explicar este punto a las familias y equipos de salud para facilitar la toma de decisiones éticamente adecuadas (25). Sin embargo, Brody et al mencionan que algunos profesionales del equipo de salud y familiares igualmente consideran que la nutrición enteral sería un tratamiento que permitiría prolongar la vida (26).…”

Challenges of Home Parenteral Nutrition for Patients with Advanced Cancer

“…However, autonomy does not mean that people can receive whatever treatment they want. Depending on the individual's overall medical history, treatment may not be appropriate or even harmful (22). The goal of this ethical principle is that the individual is fully informed of healthcare options and the individual's preferences are considered in decision-making.…”