End-of-life care, clinical ethics and nutrition therapies

Though this article was issued in 2013 the information presented remains relevant. In this article, Denise Baird Schwartz, MS, RD, FADA, CNSC explored the effects of preventive ethics and impact of intravenous nutrition therapy at the end-of-life. Schwartz also discussed various strategies RDs can implement into their practices as a way to promote better healthcare delivery. Some examples of these strategies are illustrated below:

1.     Incorporate ethics in the decision-making process
2.     Promote conversations about nutrition with patients and their families
3.     Learn about cue-based patient/family discussion as a way to educate them about nutrition therapies
4.     Become aware of cultural diversity and health literacy
5.     Utilize the teach-back method to improve health literacy
6.     Practice preventive ethics to avoid future conflicts
7.     Educate yourself on policies, procedures, and guidelines regarding clinical ethics and nutrition therapies
8.     Become aware of the available resources and tools (i.e.,  National Healthcare Decisions Day; Speak up Campaign; Aging with Dignity’s Five Wishes)

Planning for end-of-life is a team effort. When planning for end-of-life the healthcare teams should “provide appropriate and effective patient-centered care based on the individual’s wishes” (Schwartz, 2013). The patient-centered care approach is being increasingly used in the clinical setting. This approach empowers patients to make their own decisions with regards to treatment preferences and terms of care. Providing patient-centered care is also about preventing clinical ethics dilemmas. Preventing ethical conflict as it relates to “advance care planning and end-of-life discussion” (Schwartz, 2013) is often about strategic interventions like initiating nutritional support. This is a big part of the job for dietitians.

For dietitians involved in end-of-life care, initiating nutrition therapy is challenging especially if said therapy does not respect patients quality-of-life goals (Schwartz, 2013). Such dilemmas are something you want avoid. One effective measure is screening for those goals “before initiating the nutrition care process” (Schwartz, 2013). Advance directives are available for review and can be communicated between the RD, the physician, nurse, social worker and other members of the healthcare team (Schwartz, 2013).      

Schwartz, D. (2013). Ethical decision making - The dietitian’s role in end-of-life healthcare when considering enteral and parenteral nutrition. Today’s Dietitian, 15 (1), 18.


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