Ethical Considerations in Nutrition Support in Critical Care

Abstract

Critically ill patients and family members may experience contradictions among what can be done technologically, what should be done ethically, and what must be done legally, resulting in a “Troubling Trichotomy.” • Respecting the patient’s wishes and dignity is essential in patient-centered care. • Four basic tenets/principles (Autonomy, Benefi cence, Non-malefi cence, Distributive Justice) drive ethical decisions in western bioethics. • The fully educated patient or surrogate decision maker is the ultimate decision maker of whether a medical intervention, as recommended by the physician, will be undertaken. • Discussing a time limited trial of “low yield” therapy prior to starting the therapy is often helpful in dealing with family expectations. • Discussing artifi cial nutrition and hydration with patients, family members, and surrogate decision makers is crucial when the prognosis points to forgoing therapies or interventions. • Consideration of ethnic, religious, and cultural sensitivity is essential in dealing with ethical nutrition support issues in the critically ill. • Application of ethics to the critically ill requires a transdisciplinary approach, focused on the wishes and best needs of the patient. • Development of a