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The Ethics of Nutrition Support–Ripped from the HeadlinesWe all remember March 2005 when our discipline was thrust into the national spotlight with the public controversy surrounding the Terri Schiavo case. The ethical issues surrounding removal of her feeding tube were debated endlessly in our news media and led many laypersons to seek religious guidance, cling to the symbolic meaning of food, and fear—rather than embrace—advance directives regarding end-of-life decisions. The United States Congress was even engaged by passing a controversial relief bill that came to be called the "Palm Sunday Compromise." So compelling were these issues surrounding the medical therapy in which we specialize that months after the final ruling and Terri's death, these important issues still circulated in popular culture through paralleling episodes on the television shows Arrested Development, Eli Stone, and Law and Order: Special Victim's Unit. Even South Park won an Emmy Award for Outstanding Animated Program for an episode entitled `Best Friends Forever', featuring a character similar to Schiavo. While this issue was `ripped from the headlines' for everyday Americans, as experts in nutrition support we must also serve as experts regarding the complexities associated with these life-sustaining therapies and as authorities concerning its appropriate use. As such, in September 2008 the A.S.P.E.N. Board of Directiors approved the statement below regarding the ethics of withholding and/or withdrawing nutrition support therapy. In addition, I am pleased to have recently formed the A.S.P.E.N. Nutrition Support Ethics Task Force, to be chaired by Dr. Albert Barrocas, with the charge of thoroughly contemplating these important issues and developing a standalone position paper on nutrition support ethics to be reviewed and approved by the A.S.P.E.N. Board of Directors. Few are the cases, such as that of Terri Schiavo, that attract the national spotlight, but each is complex and immensely personal. The leadership and perspective we can bring to the issue is critically important and worthy of our attention.
As you contemplate this issue, I'd love to hear what's on your
mind––please send your comments, suggestions, concerns, and
thoughts to me at
ncp{at}aspen.nutr.org.
American Society for Parenteral and Enteral Nutrition Statement on Ethics of Withholding and/or Withdrawing Nutrition Support TherapyThe American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) is dedicated to improving patient care by advancing the science and practice of nutrition support therapy. Nutrition support therapy (defined here as enteral or parenteral nutrition) is provided when patients are unable to take adequate hydration or nutrients independently by mouth. Nutrition support therapy is considered a medical therapy. Withholding or withdrawing nutrition support therapy often involves different considerations than other life-sustaining therapies, in part because of emotional, religious, and symbolic meanings. The use of nutrition support therapy involves understanding the medical indications, including benefits and burdens. Next, it involves applying these interventions in a moral, ethical, and legal construct that is satisfactory to patients, families, and caregivers.
1 American Society for Parenteral and Enteral Nutrition Board of
Directors, Task Force on Standards for Specialized Nutrition Support for
Hospitalized Adult Patients: Russell MK, Andrews MR, Brewer CK, Rogers JZ,
Seidner DL. Standards for specialized nutrition support: adult hospitalized
patients. Nutr Clin Pract.2002; 17:384
-391.
Nutrition in Clinical Practice, Vol. 23, No. 6,
579-580 (2008)
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