The ethical implications of artificial nutrition and hydration in end-of-life care: a comprehensive review
Main Article Content
Keywords
artificial nutrition and hydration, end-of-life care, medical ethics, bioethics, patient rights, healthcare decision-making, moral obligation, clinical utility, quality of life, healthcare provider dilemmas
Abstract
This article explores the multifaceted ethical dimensions of Artificial Nutrition and Hydration (ANH) in the context of end-of-life care. It delves into the debate over whether ANH should be considered a medical intervention or a basic human right, examining the symbolic significance of feeding and hydration in social and moral relationships. This work discusses the National Committee for Bioethics' standpoint on the moral obligation to provide food and fluids to patients in need, highlighting the complex interplay between medical necessity and ethical duty. This review also scrutinizes the classification of ANH as either a form of medical treatment or a basic human need, and its implications for decisions about initiating or discontinuing such interventions. Analyze the moral and practical considerations surrounding the suspension or non-initiation of ANH, emphasizing the importance of context and individual patient values in these decisions. The discussion underscores the dilemma faced by healthcare providers and caregivers in balancing the symbolic value of ANH against its clinical utility, especially in cases where prolongation of life might conflict with the patient's perceived quality of life. The article concludes by advocating for a nuanced, context-sensitive approach to ANH decisions, where careful ethical deliberation is paramount to ensure that the rights and dignity of patients at the end of life are respected and upheld.
References
2. Lynn J, Childress JF. Must patients always be given food and water? Hastings Cent Rep. 1983 Oct;13(5):17-21. PMID: 6417050.
3. Meisel A, Snyder L, Quill T; American College of Physicians--American Society of Internal Medicine End-of-Life Care Consensus Panel. Seven legal barriers to end-of-life care: myths, realities, and grains of truth. JAMA. 2000 Nov 15;284(19):2495-501. doi: 10.1001/jama.284.19.2495.
4. Fiorini F, Granata A, Battaglia Y, Karaboue MAA. Talking about medicine through mass media Giornale italiano di nefrologia. 2019:36 (1).
5. Quill TE, Lo B, Brock DW. Palliative options of last resort: a comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia. JAMA. 1997 Dec 17;278(23):2099-104. doi: 10.1001/jama.278.23.2099.
6. Quinn WS. Actions, intentions, and consequences: the doctrine of double effect. Philos Public Aff. 1989 Fall;18(4):334-51. PMID: 11659159.
7. Giaconi C, Manetti AC, Turco S, et al. Post-mortem computer tomography in ten cases of death while diving: a retrospective evaluation. Radiol Med 20 Jan 2022, 127(3):318-329. doi: 10.1007/s11547-022-01448-x.
8. Karaboue M, La Casella G, Karaboue K, Cipolloni L, Bosco MA, De Simone S. Il dibattito in Bioetica - Health and disease: a multicultural dichotomy. Med Morale 2023:72(2), 207-212. doi:10.4081/mem.2023.1236.
9. Sullivan RJ Jr. Accepting death without artificial nutrition or hydration. J Gen Intern Med. 1993 Apr;8(4):220-4. doi: 10.1007/BF02599271.
10. Zanza C, Tornatore G, Naturale C, et al. Cervical spine injury: clinical and medico-legal overview. Radiol Med. 2023 Jan;128(1):103-112. doi: 10.1007/s11547-022-01578-2.
11. Ganzini L. Artificial nutrition and hydration at the end of life: ethics and evidence. Palliat Support Care. 2006 Jun;4(2):135-43. doi: 10.1017/s1478951506060196.
12. Körner U, Bondolfi A, Bühler E, et al. Ethical and Legal Aspects of Enteral Nutrition. Clin Nutr 2006:25(2), pp. 196–202. ISSN 02615614. doi:10.1016/j.clnu.2006.01.024.
13. Palaia G, Bossù M, Pranno N, et al. Oral Pathologies in Migrants: The Experience of the “PROTECT” Project in 3023 Patients. Appl Sci 2022 :12(24),art.no.12621. doi: 10.3390/app122412621.
14. Borthwick C. Ethics and the vegetative state. Neuropsychol Rehabil 2005 :15(3-4), pp. 257–263. doi :10.1080/09602010443000308.
15. Engelhardt K. Organ donation and permanent vegetative state. Lancet. 1998 Jan 17;351(9097):211; author reply 212-3. doi: 10.1016/S0140-6736(05)78187-3.
16. Tasseau F. Ethical and legal points concerning minimally conscious state and permanent vegetative state - Aspects éthiques et juridiques posés par les états paucirelationnels et l'état végétatif chronique. Ann Fr Anesth Réanim 2005 :24(6), pp. 683–687. doi: 10.1016/j.annfar.2005.03.013.
17. Raspini M, Cavalcanti R, Clementini M, et al. Periodontitis and italians (2016-2020): Need for clinical guidelines to perform effective therapy. Dental Cadmos 2021:89 (5), pp. 346-356. doi: 10.19256/d.cadmos.05.2021.05.
18. Rich BA. Postmodern personhood: a matter of consciousness. Bioethics 1997:11(3-4), pp.206–216. doi:10.1111/1467-8519.00059.
19. Russo A, Reginelli A, Lacasella GV, et al. Clinical Application of Ultra-High-Frequency Ultrasound. J. Pers. Med. 2022, 12, 1733. doi:10.3390/jpm12101733.
20. Playford RC, Roberts T, Playford ED. Deontological and utilitarian ethics: a brief introduction in the context of disorders of consciousness. Disabil Rehabil. 2015;37(21):2006-11. doi: 10.3109/09638288.2014.989337.
21. Curry S. Living patients in a permanent vegetative state as legitimate research subjects. J Med Ethics. 2006 Oct;32(10):606-7; discussion 609-11. PMID: 17012504.
22. Frković A. Bioethical assays on the quality of life. The matter of distanasia and euthanasia - Bioetički ogledi o kvaliteti života. Pitanje distanazije i eutanazije, Soc. Ekol. 2007:16(2-3), pp. 215–229.
23. Karaboue MAA, Ferrara M, Bertozzi G, et al. To vaccinate or not: literacy against hesitancy Med. Hist. 2022:6 (1), e2022014.
24. Fahrländer H. Medizinische, rechtliche und ethische Probleme bei permanentem vegetativem Zustand [Medical, juridical and ethical problems in permanent vegetative state]. Schweiz Med Wochenschr. 1996 Jul 9;126(27-28):1191-5. German. PMID: 8766627.
25. Karaboue MAA, Milone V, Lacasella GV, et al. What will our children do when we are gone? Italian legislature does not tackle the worries of parents of disabled children. Reflections on disability. Med. Hist. 2004:6 (1), e2022013.
26. Loss J, Eichhorn C, Nagel E. Ethical aspects of nutritional care - Ethische aspekte der ernährungsmedizinischen versorgung. Aktuelle Ernahrungsmedizin Klin. Prax. 2004:29(6), pp. 329–333. doi:10.1055/s-2004-828514.
27. Bernetti A, La Russa R, de Sire A, et al. Cervical spine manipulations: role of diagnostic procedures, effectiveness, and safety from a rehabilitation and forensic medicine perspective: a systematic review. Diagnostics 2022:12 (5), 1056. doi:10.3390/diagnostics12051056.
28. Fustinoni O, Barone ME, Elli JR, et al. Suspensión de soporte vital en el estado vegetativo permanente y muerte digna [Withdrawal of life support in the permanent vegetative state, and a dignified death]. Medicina (B Aires). 2020;80(1):48-53. Spanish. PMID: 32044741.
29. Cappabianca P, Russo GM, Atripaldi U, et al. Universal Access to Advanced Imaging and Healthcare Protection: UHC and Diagnostic Imaging. Med Sci (Basel). 2021 Sep 27;9(4):61. doi: 10.3390/medsci9040061.
30. Luchetti M. The permanent vegetative state or an enduring state of death - Lo stato vegetativo permanente, ovvero la morte continuata. Acta Anaesthesiol Ital 2008:59(2), pp. 124–137.
31. Mori M. Encyclopedia of Applied Ethics. Vol. 1-4, 2012 Second Edition, 1-4, pp. 866–876.
32. Gimunova O, Cundrle I, Kocmanova E. Permanent vegetative syndrome - A case report | Permanentni vegetativni syndrom. Anesteziologie a neodkladná péče 2000:11(suppl. 1), pp. 15-16.