Ethical Implications of Nutrition Therapy at the End of Life

Abstract

Purpose of review: Provide an evidence-based resource to inform ethically sound recommendations regarding end of life nutrition therapy.

Recent findings: • Some patients with a reasonable performance status can temporarily benefit from medically administered nutrition and hydration(MANH) at the end of life. • MANH is contraindicated in advanced dementia. • MANH eventually becomes nonbeneficial or harmful in terms of survival, function, and comfort for all patients at end of life. • Shared decision-making is a practice based on relational autonomy, and the ethical gold standard in end of life decisions. A treatment should be offered if there is expectation of benefit, but clinicians are not obligated to offer non-beneficial treatments. A decision to proceed or not should be based on the patient's values and preferences, a discussion of all potential outcomes, prognosis for given outcomes taking into consideration disease trajectory and functional status, and physician guidance provided in the form of a recommendation.

Keywords: Artificial nutrition; End of life; Enteral nutrition; Ethics; Medically administered nutrition; Parenteral nutrition; Shared decision-making.