The debate over use of artificial nutrition and hydration (anh) in terminal illness, including advanced dementia, remains contentious despite extensive ethical and empirical investigation methods for this narrative review we undertook a focused, selective review of literature reflecting ethical analysis, empirical assessment of outcomes, legal responses, and thinking within the roman catholic religious tradition. For comatose patients and patients in a persistent vegetative state artificial nutrition is a necessary support to bridge the time until either recovery is imminent or improbable. Ethical issues palliative sedation represents a part even if the patient is comatose et al forgoing artificial nutrition or hydration in patients nearing . Ethical issues in artificial nutrition and hydration brain-injured patients, including both comatose and vegetative patients ethical and legal issues in . In the last century, with the advent of plastic tubing, new ethical issues have been raised regarding nutrition and hydration of patients in comatose, or that of persistent vegetative states.
The intent of this review is to supply a framework of clinical practices, ethical principles, legal precedents, and professional guidelines that will impart information and can assist decision making regarding artificial nutrition and hydration. Lastly, the ethics consultant would make certain that withdrawal of nutrition and hydration from a patient in a persistent vegetative state is not prohibited by state law  the erd states that a person may forgo extraordinary or disproportionate means of preserving life. When artificial nutrition and hydration are required for the medium term or longer, this should be managed by the multidisciplinary team together with other health professionals, the patients themselves and their family/carers, at home if possible. Start studying health care ethics 201 who makes the decisions regarding an incapacitated patient's medical care patient from artificial nutrition and .
Nutrition and hydration the patient, family, and caregivers are encouraged to share any concerns or information regarding medically provided nutrition and hydration with the others most closely involved in the patient’s care 4 we believe decisions about medically providing nutrition and hydration should be made on the best available information. The ethical issues have been discussed over the past 40 or 50 years, with the current consensus being that anh are medical interventions with benefits and burdens akin to other medical interventions decisions around anh involve the ethical principles of patient autonomy, beneficence, and nonmaleficence. For those patients who are irreversibly comatose or who are imminently going to die or who are in a persistent vegetative state (pvs), the question of withholding or withdrawing the nutrition and fluids that they have been receiving through feeding tubes, has become an ethical dilemma for those responsible for care.
Patients do not feel pain, these physicians could be expected to act accordingly, for instance, by not providing analgesic medication to these patients during care or during the dying process after withdrawal of artificial hydration and nutrition , the latter on the grounds that these patients do not experience suffering from hunger or thirst . Chronic disorders of consciousness following coma including artificial nutrition and hydration, evidence of the patients' wishes regarding the latter . The provision of hydration and nutrition is an essential part of human flourishing families and professionals struggle with any thought of withdrawing clinically assisted hydration and nutrition up to and including the last hours or days of life. Ethics in disorders of consciousness ethical issues in clinical management or during the dying process after withdrawal of artificial hydration and nutrition. The ethics of artificial nutrition and hydration medical ethics, at least as practiced at the bedside in the form of clinical ethics, properly starts with medical science and then moves to human behavior, spirituality, health law, and finally moral argumentation.
End of life care: an ethical overview nutrition and hydration, research with dying patients 49 ethical issues after death of patient 50. Minimally conscious state: these patients are also alive, with a severe alteration in consciousness, with intermittent, but inconsistent, behaviors suggesting awareness contrary to patients in coma or a vegetative state, minimally conscious patients may occasionally have purposeful movements, and they may track motions with their eyes or speak. Permanently unconscious patients and the ethical controversies surrounding artificial nutrition and hydration: getting the facts straight by kenneth r mitcheu clinical ethics and law. The ethical dilemmas included inadequate communication, provision of nonbeneficial care, patient autonomy usurped/threatened, issues with symptom management and the use of opioids, issues related to decision making, and issues related to discontinuing life-prolonging therapies.
Making decisions with families at the end of life the physician must discuss end-of-life issues with the family members of these patients the legal, ethical, and nutrition and hydration17. Palliative care and ethics in the neuroscience patient comatose patients with any 4 of the following on day 3 of coma artificial nutrition and hydration. 5 if the result of withholding or withdrawing nutrition and hydration is death by starvation and dehydration, as opposed to an undying disease or dysfunction, it is gravely immorally in summary, nutrition and hydration, like bathing and changing the patient's position to avoid bedsores, is ordinary care that is owed to the patient.
It appears that, for some, starvation and dehydration are rather uncomfortable and provision of food and fluids contribute to comfort this is not true for all (eg, comatose patients) food and fluid have a definite symbolic role they imply care it is satisfying to know that we are meeting the needs of our loved ones. Ethical issues in withholding or withdrawal of artifical nutrition and hydration everyday practice when they deal with ethical problems regarding patient’s anh . Common questions and answers about severe brain injury patients in a coma are treated with supportive care artificial nutrition and hydration they also receive. The feeding tube dilemma: key questions post date: 01/27/2006 the medical literature as to how much artificial nutrition and hydration help at the time of death .
Decision-making about accepting or refusing clinically appropriate nutrition and hydration at the end of life nurses will have adequate and accurate information to understand patients’ cultural, ethnic, and religious beliefs and values regarding nutrition and hydration at the end of life patients’ views and beliefs should be respected. For comatose patients and patients in a persistent vegetative state artificial nutrition is a necessary support to bridge the time until either recovery is imminent or improbable at that moment artificial nutrition no longer contributes to the life of the patient and should be ceased.