END OF LIFE ARTIFICIAL NUTRITION AND HYDRATION

Emily Vale

End of life vs. Palliative Care

End of life Final days and hours of life1

Palliative care Improving quality of life Associated with life-threatening illness1

Patient-Centered Care1

New trend in health systems Quality of life Removed focus from illness/disease Focus on health

Artificial Nutrition and Hydration2

Medical treatment Receiving nutrition and hydration

through an IV or PEG tube Patient not able to take by mouth

End of Life Care Views3

Newer views on end of life care Current views challenged Multiple positions

Ethical Legal Medical Hospice Religious

Ethical3

Principalism Autonomy Beneficence Nonmaleficence Justice

Deontology Utilitarianism

Medical3

Uses prinicipalism Core principals:

Autonomy Beneficence Nonmaleficence Justice

Hospice2

Artificial nutrition and hydration (ANH) is different than eating or drinking

ANH does not cure the individual ANH refusal is not suicide

Religious3

Many different religions and views Examples:

Roman Catholicism Judaism - three divisions Presbyterian Church

Legal

Advance directives Living wills Powers of attorney Surrogate

Judicial system Legislative system

Does Age Matter?

Advanced age patients have decreased health care spending4

Doctor statement Easier in older patients compared to

younger5

Hunger or Thirst?

Van der Riet et al. (2006) conducted research Interviews of terminally ill inpatients and

family No complaints of hunger or thirst

Easier Said Than Done

Discord amongst medical professionals Discord amongst families

Terri Schaivo case

Resources

1. Fleming M, Hollins Martin CJ, Martin CR: Nutritional intervention and quality of life in palliative care patients. British Journal of Nursing November 2011; 20(20): 1320-1324. Available from Academic Search Complete, Health Sources: Nursing/Academic Edition

2. National Hospice and Palliative Care Organization. (2009). Artificial nutrition (food) and hydration (fluids) at the end of life. Retrieved from http://www.caringinfo.org/files/public/brochures/ArtificialNutritionAndHydration.pdf

3. Andrews MR, Geppert, CMA (2007). The A.S.P.E.N. Nutrition Support Core Curriculum. United States: American Society for Parenteral and Enteral Nutrition.

Resources

4. Somogyi-Zalud E, Zhong Z, Hamel MB, Lynn J: The use of life-sustaining treatments in hospitalized persons aged 80 and older. Journal of the American Geriatrics Society May 2002; 50(5): 930-934. Available from Academic Search Complete.

5. Van der Riet P, Higgins I, Good P, Sneesby L: A discourse of difficult clinical situations in relation to nutrition and hydration during end of life care. Journal of Clinical Nursing July 2009; 18(14): 2104-2111. Available from CINAHL Plus with Full Text.