End of Life Nutrition

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The Nutrition Care Manual has a section that discusses the importance of nutrition and hydration issues at the end of life and ethical issues.

“The goals of care must first be established in order to provide appropriate nutritional therapy. In end-of-life care, the registered dietitian’s assessment requires the practitioner to consider not only the clinical nutrition needs of the person, but the medical goals of the patient (restorative, supportive, palliative, or comfort). The dietitian must also address the psychosocial, spiritual, behavioral, and philosophical issues facing the patient as well.”
“Palliative care is the active, total care of a patient when curative measures are no longer an option. Palliative care, including nutrition-related care, does not imply indifference or inferior care. Nutrition goals are no longer curative; reversing malnutrition may not be possible or appropriate. Patient choice, optimal quality of life, and maintaining dignity are paramount. Clarity is critical to minimize philosophical bias when conveying nonjudgmental information.”
“The dietitian must also be aware that the client has the right to refuse nutrition and hydration (PRNH) is not new. Some believe PRNH falls in the ethical category of ‘voluntary passive euthanasia.”
“Some reports suggest the effectiveness of advance directives and the ethical dilemmas concerning the withdrawal of artificial nutrition and hydration at the end of life. It has been determined that advance directives do play an important role with regard to end of life decisions concerning feeding tubes.”
“By foregoing aggressive nutrition therapy, the following decreases in symptoms, although not all-encompassing, may benefit the patient:
·         Gastrointestinal and venous distention
·         Nausea
·         Vomiting
·         Potential for aspiration
·         Diarrhea
·         Urinary problems
·         Pulmonary secretions

Academy of Nutrition and Dietetics. Nutrition Care Manual. End of Life Nutrition. http://nutritioncaremanual.org/content.cfm?ncm_content_id=92029. Accessed March 31, 2013.
PG

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