Ethical and Legal Aspects of Nutritional Support

Abstract

The provision of Clinically Assisted Nutrition and Hydration (CANH) often presents an ethical challenge to many clinicians; in the context of changing health and social demographics, this challenge is set to increase. The subject is incredibly emotive for patients, relatives and carers, and staff as the provision of food and water represent the most basic requirements for life.

Modern society is an amalgam of different religious, ethnic and cultural backgrounds, and beliefs. Attitudes to end-of-life care and the sanctity of life vary widely between different groups. This will also be present within a multi-professional healthcare team and there is guidance available to support discussions and decision making for ethically complex care.

The legal position regarding the provision of CANH varies between countries and states; however, all clinicians have a morale and professional responsibility to act within the principles of medical ethics and respect the wishes of patients accepting that a patient does not have the right to obtain every treatment they wish or request if the treatment is not medically indicated.

Some of the most challenging situations arise in patients who lack capacity. The first question should be ‘what are we trying to achieve’? If in doubt, a trial of clinically assisted nutrition and hydration with clearly agreed objectives may be appropriate.