ESPEN guideline on ethical aspects of artificial nutrition and hydration

Clinical Nutrition

Volumn 35, Issue 3, 2016, Pages 545-556

  Druml, Christiane ^a   Ballmer, Peter E ^b   Druml, Wilfred ^a   Oehmichen, Frank ^c   Shenkin, Alan ^d   Singer, Pierre ^e   Soeters, Peter ^f   Weimann, Arved ^g   Bischoff, Stephan C ^h  

^a MEDICAL UNIVERSITY OF VIENNA   (Austria)

^b CANTONAL HOSPITAL WINTERTHUR   (Switzerland)

^c Klinik Bavaria in Kreischa GmbH   (Germany)

^d UNIVERSITY OF LIVERPOOL   (United Kingdom)

^e RABIN MEDICAL CENTER   (Israel)

^f MAASTRICHT UNIVERSITY MEDICAL CENTER   (Netherlands)

^g Klinikum St Georg   (Germany)

^h UNIVERSITY OF HOHENHEIM   (Germany)

Author keywords

Artificial nutrition; Culture and religion; Enteral nutrition; Ethics and law; Hydration; Parenteral nutrition

Indexed keywords

ARTICLE; ARTIFICIAL FEEDING; CAREGIVER; COMMUNICATION SKILL; COMPETENCE; CULTURAL FACTOR; DEMENTIA; DIET THERAPY; ENTERIC FEEDING; FLUID THERAPY; HEALTH BELIEF; HEALTH SURVEY; HUMAN; INFORMED CONSENT; INTENSIVE CARE UNIT; JUSTICE; LEGAL ASPECT; LIVING WILL; MEDICAL ETHICS; MEDICAL SOCIETY; NURSING CARE; ONLINE SYSTEM; PALLIATIVE THERAPY; PARENTERAL NUTRITION; PATIENT AUTONOMY; PERSISTENT VEGETATIVE STATE; PERSONALIZED MEDICINE; PHYSICIAN; PRACTICE GUIDELINE; QUALITY OF LIFE; RELIGION; TERMINAL CARE; TREATMENT REFUSAL; ADULT; CONSENSUS DEVELOPMENT; DIETETICS; ETHICS; EUROPE; EVIDENCE BASED MEDICINE; HEALTH CARE ORGANIZATION; HUMAN RELATION; LEGISLATION AND JURISPRUDENCE; MEDICOLEGAL ASPECT; NURSING; NUTRITIONAL SUPPORT; PATIENT ATTITUDE; PERSONAL AUTONOMY; PROFESSIONAL-PATIENT RELATIONSHIP; STANDARDS; TRANSCULTURAL CARE; TREATMENT WITHDRAWAL;

ADULT; CULTURALLY COMPETENT CARE; DIETETICS; EUROPE; EVIDENCE-BASED MEDICINE; FLUID THERAPY; HUMANS; LEGISLATION, MEDICAL; NUTRITIONAL SUPPORT; PALLIATIVE CARE; PATIENT ACCEPTANCE OF HEALTH CARE; PERSONAL AUTONOMY; PRECISION MEDICINE; PROFESSIONAL-FAMILY RELATIONS; PROFESSIONAL-PATIENT RELATIONS; QUALITY OF LIFE; SOCIETIES, SCIENTIFIC; TERMINAL CARE; WITHHOLDING TREATMENT;

EID: 84959238282     PISSN: 02615614     EISSN: 15321983     Source Type: Journal    
DOI: 10.1016/j.clnu.2016.02.006     Document Type: Article

References (80)

1. Oehmichen F., Ballmer P.E., Druml C., Junek R., Kolb C., Körner U., et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) - Ethische und rechtliche Gesichtspunkte der Künstlichen Ernährung. Aktuel Ernahrungsmed 2013, 38:112-117.
2. Bischoff S.C., Singer P., Koller M., Barazzoni R., Cederholm T., van Gossum A. Standard operating procedures for ESPEN guidelines and consensus papers. Clin Nutr 2015, 34:1043-1051.
3. Valentini L., Volkert D., Schütz T., Ockenga J., Pirlich M., Druml W., et al. Suggestions for terminology in clinical nutrition. e-SPEN J 2014, 9:e97-e108.
4. Beauchamp T.L., Childress J.F. Principles of biomedical ethics 2001, Oxford University Press, USA, ISBN-13: 978-0195143324. 5th ed.
5. Korner U., Bondolfi A., Buhler E., Macfie J., Meguid M.M., Messing B., et al. Ethical and legal aspects of enteral nutrition. Clin Nutr 2006, 25:196-202.
6. Geppert C.M., Andrews M.R., Druyan M.E. Ethical issues in artificial nutrition and hydration: a review. J Parenter Enteral Nutr 2010, 34:79-88.
7. Watson R. Council of Europe issues guide to end of life care. BMJ 2014, 348:g3167. (06.08.2015). http://www.coe.int/en/web/bioethics/end-of-life.
8. McCann R.M., Hall W.J., Groth-Juncker A. Comfort care for terminally ill patients. The appropriate use of nutrition and hydration. J Am Med Assoc 1994, 272:1263-1266.
9. Casarett D., Kapo J., Caplan A. Appropriate use of artificial nutrition and hydration-fundamental principles and recommendations. N Engl J Med 2005, 353:2607-2612.
10. CREST (Clinical Resource Efficiency Support Team) Guidelines for the management of enteral tube feeding in adults April 2004, (06.08.2015). http://www.irspen.ie/wp-content/uploads/2014/10/CREST_A_model_for_managing_enteral_tube_feeding.pdf.
11. Weimann A. Ethical issues of artificial nutritional support. Ther Umsch 2014, 71:177-183.
12. Steffee W.P. Malnutrition in hospitalized patients. J Am Med Assoc 1980, 244:2630-2635.
13. Hiesmayr M., Schindler K., Pernicka E., Schuh C., Schoeniger-Hekele A., Bauer P., et al. Decreased food intake is a risk factor for mortality in hospitalised patients: the NutritionDay survey 2006. Clin Nutr 2009, 28:484-491.
14. European Commission Food supplements 01.07.2015, (06.08.2015). http://ec.europa.eu/food/safety/labelling_nutrition/supplements/index_en.htm.
15. Pirlich M., Lochs H. Nutrition in the elderly. Best Pract Res Clin Gastroenterol 2001, 15:869-884.
16. Skelly R.H. Are we using percutaneous endoscopic gastrostomy appropriately in the elderly?. Curr Opin Clin Nutr Metab Care 2002, 5:35-42.
17. Mitchell S.L., Tetroe J., O'Connor A.M. A decision aid for long-term tube feeding in cognitively impaired older persons. J Am Geriatr Soc 2001, 49:313-316.
18. Hoefler J.M. Making decisions about tube feeding for severely demented patients at the end of life: clinical, legal, and ethical considerations. Death Stud 2000, 24:233-254.
19. Mitchell S.L., Teno J.M., Roy J., Kabumoto G., Mor V. Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairment. J Am Med Assoc 2003, 290:73-80.
20. Gillick M.R. Rethinking the role of tube feeding in patients with advanced dementia. N Engl J Med 2000, 342:206-210.
21. Palecek E.J., Teno J.M., Casarett D.J., Hanson L.C., Rhodes R.L., Mitchell S.L. Comfort feeding only: a proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia. J Am Geriatr Soc 2010, 58:580-584.
22. Austrian Bioethics Commission Recommendations for the terminology of medical decisions in end-of-life situations 2011, (06.08.2015). http://www.bka.gv.at/DocView.axd?CobId=46713.
23. Jaul E., Singer P., Calderon-Margalit R. Tube feeding in the demented elderly with severe disabilities. Isr Med Assoc J 2006, 8:870-874.
24. Austrian Bioethics Commission Dying with dignity - recommendations on assistance and care for persons in end-of-life situations and related issues 2015, (19.10.2015). https://www.bka.gv.at/DocView.axd?CobId=58509.
25. Gillick M.R., Volandes A.E. The standard of caring: why do we still use feeding tubes in patients with advanced dementia?. J Am Med Dir Assoc 2008, 9:364-367.
26. Schwartz D.B., Barrocas A., Wesley J.R., Kliger G., Pontes-Arruda A., Marquez H.A., et al. Gastrostomy tube placement in patients with advanced dementia or near end of life. Nutr Clin Pract 2014, 29:829-840.
27. Schwartz D.B., DiTucci A., Goldman B., Gramigna G.D., Cummings B. Achieving patient-centered care in a case of a patient with advanced dementia. Nutr Clin Pract 2014, 29:556-558.
28. Medical aspects of the persistent vegetative state (1) The multi-society task force on PVS. N Engl J Med 1994, 330:1499-1508.
29. Bozzetti F. Nutrition, hydration, and patient's preferences at the end of life. Support Care Cancer 2015, 23:1487-1488.
30. Bukki J., Unterpaul T., Nubling G., Jox R.J., Lorenzl S. Decision making at the end of life-cancer patients' and their caregivers' views on artificial nutrition and hydration. Support Care Cancer 2014, 22:3287-3299.
31. Marckmann G., Sandberger G., Wiesing U. Limiting life-prolonging treatments: a practical guidance reflecting the current legislation in Germany. Dtsch Med Wochenschr 2010, 135:570-574.
32. Slomka J. Withholding nutrition at the end of life: clinical and ethical issues. Cleve Clin J Med 2003, 70:548-552.
33. Sherman F.T. Nutrition in advanced dementia. Tube-feeding or hand-feeding until death?. Geriatrics 2003, 58(10):12.
34. Bruera E., Belzile M., Watanabe S., Fainsinger R.L. Volume of hydration in terminal cancer patients. Support Care Cancer 1996, 4:147-150.
35. Bruera E., MacDonald N. To hydrate or not to hydrate: how should it be?. J Clin Oncol 2003, 21:84s-85s. discussion 86s.
36. Bruera E., Hui D., Dalal S., Torres-Vigil I., Trumble J., Roosth J., et al. Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol 2013, 31:111-118.
37. Good P., Richard R., Syrmis W., Jenkins-Marsh S., Stephens J. Medically assisted hydration for adult palliative care patients. Cochrane Database Syst Rev 2014, 4:CD006273.
38. Schildmann E., Schildmann J. Palliative sedation therapy: a systematic literature review and critical appraisal of available guidance on indication and decision making. J Palliat Med 2014, 17:601-611.
39. Finucane T.E., Christmas C., Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. J Am Med Assoc 1999, 282:1365-1370.
40. Synofzik M. Tube-feeding in advanced dementia. An evidence-based ethical analysis. Nervenarzt 2007, 78:418-428.
41. Buser C.S. Needs of caregivers and needs of the dying regarding food. Schweiz Rundsch Med Prax 1993, 82:1033-1038.
42. McNamara E.P., Kennedy N.P. Tube feeding patients with advanced dementia: an ethical dilemma. Proc Nutr Soc 2001, 60:179-185.
43. Mitchell S.L., Buchanan J.L., Littlehale S., Hamel M.B. Tube-feeding versus hand-feeding nursing home residents with advanced dementia: a cost comparison. J Am Med Dir Assoc 2003, 4:27-33.
44. Mitchell S.L., Kiely D.K., Gillick M.R. Nursing home characteristics associated with tube feeding in advanced cognitive impairment. J Am Geriatr Soc 2003, 51:75-79.
45. Valentin A., Druml W., Steltzer H., Wiedermann C.J. Recommendations on therapy limitation and therapy discontinuation in intensive care units: consensus paper of the Austrian associations of intensive care medicine. Intensive Care Med 2008, 34:771-776.
46. Hynninen M., Klepstad P., Petersson J., Skram U., Tallgren M. Process of foregoing life-sustaining treatment: a survey among Scandinavian intensivists. Acta Anaesthesiol Scand 2008, 52:1081-1085.
47. Latour J.M., Fulbrook P., Albarran J.W. EfCCNa survey: European intensive care nurses' attitudes and beliefs towards end-of-life care. Nurs Crit Care 2009, 14:110-121.
48. Brett A.S., Rosenberg J.C. The adequacy of informed consent for placement of gastrostomy tubes. Arch Intern Med 2001, 161:745-748.
49. Prochaska M.T., Sulmasy D.P. Recommendations to surrogates at the end of life: a critical narrative review of the empirical literature and a normative analysis. J Pain Symptom Manage 2015 May 27, pii: S0885-3924(15)00246-8. [Epub ahead of print]. 10.1016/j.jpainsymman.2015.05.004.
50. Lemke R. PEG installation in patients unable to give informed consent. Dtsch Med Wochenschr 2003, 128:160.
51. Paul N.W., Fischer A. Advance health care directives: perception and reality. Results of a random survey. Dtsch Med Wochenschr 2008, 133:175-179.
52. Gillick M.R. The use of advance care planning to guide decisions about artificial nutrition and hydration. Nutr Clin Pract 2006, 21:126-133.
53. Wiesing U., Jox R.J., Hessler H.J., Borasio G.D. A new law on advance directives in Germany. J Med Ethics 2010, 36:779-783.
54. Veshi D., Neitzke G. Advance directives in some western european countries: a legal and ethical comparison between Spain, France, England, and Germany. Eur J Health Law 2015, 22:321-345.
55. Yamaguchi Y., Mori H., Ishii M., Okamoto S., Yamaguchi K., Iijima S., et al. Interview- and questionnaire-based surveys on elderly patients' wishes about artificial nutrition and hydration during end-of-life care. Geriatr Gerontol Int 2015 Oct 13, [Epub ahead of print]. 10.1111/ggi.12615.
56. Schneiderman L.J., Gilmer T., Teetzel H.D., Dugan D.O., Blustein J., Cranford R., et al. Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial. J Am Med Assoc 2003, 290:1166-1172.
57. Loeser C., von Herz U., Kuchler T., Rzehak P., Muller M.J. Quality of life and nutritional state in patients on home enteral tube feeding. Nutrition 2003, 19:605-611.
58. Kunin J. Withholding artificial feeding from the severely demented: merciful or immoral? Contrasts between secular and Jewish perspectives. J Med Ethics 2003, 29:208-212.
59. Ferrie S. A quick guide to ethical theory in healthcare: solving ethical dilemmas in nutrition support situations. Nutr Clin Pract 2006, 21:113-117.
60. Buckley T., Crippen D., DeWitt A.L., Fisher M., Liolios A., Scheetz C.L., et al. Ethics roundtable debate: withdrawal of tube feeding in a patient with persistent vegetative state where the patients wishes are unclear and there is family dissension. Crit Care 2004, 8:79-84.
61. Truog R.D., Cochrane T.I. Refusal of hydration and nutrition: irrelevance of the "artificial" vs "natural" distinction. Arch Intern Med 2005, 165:2574-2576.
62. Ganzini L., Goy E.R., Miller L.L., Harvath T.A., Jackson A., Delorit M.A. Nurses' experiences with hospice patients who refuse food and fluids to hasten death. N Engl J Med 2003, 349:359-365.
63. Chabot B.E., Goedhart A. A survey of self-directed dying attended by proxies in the Dutch population. Soc Sci Med 2009, 68:1745-1751.
64. Winter S.M. Terminal nutrition: framing the debate for the withdrawal of nutritional support in terminally ill patients. Am J Med 2000, 109:723-726.
65. Brody H., Hermer L.D., Scott L.D., Grumbles L.L., Kutac J.E., McCammon S.D. Artificial nutrition and hydration: the evolution of ethics, evidence, and policy. J Gen Intern Med 2011 Sep, 26:1053-1058.
66. Ethics Position Paper Task Force A.S.P.E.N., Barrocas A., Geppert C., Durfee S.M., Maillet J.O., Monturo C., et al. A.S.P.E.N. ethics position paper. Nutr Clin Pract 2010, 25:672-679.
67. Vincent J.L. Cultural differences in end-of-life care. Crit Care Med 2001, 29:N52-N55.
68. Heuberger R.A. Artificial nutrition and hydration at the end of life. J Nutr Elder 2010, 29:347-385.
69. Catechism of the Catholic Church, Article 2278; (06.08.2015). http://www.vatican.va/archive/ccc_css/archive/catechism/p3s2c2a5.htm.
70. Sulmasy DP. Are Feeding Tubes Morally Obligatory? (06.08.2015). http://www.americancatholic.org/messenger/jan2006/feature1.asp.
71. Harvey J.C. The burdens-benefits ratio consideration for medical administration of nutrition and hydration to persons in the persistent vegetative state. Christ Bioeth 2006, 12:99-106.
72. Phua J., Joynt G.M., Nishimura M., Deng Y., Myatra S.N., Chan Y.H., et al. Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA Intern Med 2015, 175:363-371.
73. Pauls M., Hutchinson R.C. Bioethics for clinicians: 28. Protestant bioethics. CMAJ 2002, 166:339-343.
74. Steinberg A., Sprung C.L. The dying patient: new Israeli legislation. Intensive Care Med 2006, 32:1234-1237.
75. Bulow H.H., Sprung C.L., Reinhart K., Prayag S., Du B., Armaganidis A., et al. The world's major religions' points of view on end-of-life decisions in the intensive care unit. Intensive Care Med 2008, 34:423-430.
76. Alsolamy S. Islamic views on artificial nutrition and hydration in terminally ill patients. Bioethics 2014, 28:96-99.
77. The World Medical Association Declaration of Tokyo. Guidelines for physicians concerning torture and other cruel, inhuman or degrading treatment or punishment in relation to detention and imprisonment. World Med J 2006, 52:34. WMA Adopted by the 29th World Medical Assembly, Tokyo, Japan, October 1975 and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006.
78. Röggla G. Medically enforced feeding of detained asylum seekers on hunger strike. Wien Klin Wochenschr 2005, 117:436.
79. Annas G.J., Crosby S.S., Glantz L.H. Guantanamo Bay: a medical ethics-free zone?. N Engl J Med 2013, 369:101-103.
80. Crosby S.S., Apovian C.M., Grodin M.A. Hunger strikes, force-feeding, and physicians' responsibilities. J Am Med Assoc 2007, 298:563-566.