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Ethical Considerations in Nutrition Support in Critical Care

  • Chapter
Nutrition Support for the Critically Ill

Part of the book series: Nutrition and Health ((NH))

Abstract

Paradoxically, the most ethically troubling decisions in critical care involve therapies of little or no utility. Rarely is the decision to do something questioned by care-givers or family. But the decision to withhold treatment or to discontinue “low yield” therapy is always troubling. Nowhere is this more difficult than with nutrition support. As care-givers, we have a positive duty to feed our patients under most circumstances. It would be unethical to withhold oral feedings without good cause, for example. But what about enteral and, even more troubling, parenteral nutrition? There are clearly circumstances in which continuing to feed a terminal patient, either by feeding tube or intravenously, is simply prolonging death. These issues call for basic consideration of the four tenets of ethics: autonomy, beneficence, non-maleficence, and distributive justice. Bringing the patient’s family to accept withdrawal of nutrition care requires trust, which can be gained only be frequent and honest communication. Even then, cultural, religious, and individual factors may play a large part in the family’s decision. Managing these decisions requires involvement by all of the health care team, as well as by the patient’s family.

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Authors and Affiliations

  1. Atlanta Medical Center, 4050 Spalding Drive, Atlanta, GA, 30312, USA

    Albert Barrocas MD, FACS, FASPEN

  2. Food and Nutrition Services, Providence Saint Joseph Medical Center, Burbank, CA, USA

    Denise Baird Schwartz MS, RD, CNSC, FASPEN

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  1. Albert Barrocas MD, FACS, FASPEN
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  2. Denise Baird Schwartz MS, RD, CNSC, FASPEN
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Correspondence to Albert Barrocas MD, FACS, FASPEN .

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Editors and Affiliations

  1. Institute of Human Nutrition, Columbia University College of Physicians and Surgeons, New York, New York, USA

    David S. Seres

  2. Department of Surgery, University of Missouri, Kansas City, Kansas City, Missouri, USA

    Charles W. Van Way, III

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Barrocas, A., Schwartz, D.B. (2016). Ethical Considerations in Nutrition Support in Critical Care. In: Seres, D., Van Way, III, C. (eds) Nutrition Support for the Critically Ill. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-21831-1_12

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