Ethical Aspects of Artificially Administered Nutrition and Hydration: An ASPEN Position Paper

Denise Baird Schwartz, Albert Barrocas, Maria Giuseppina Annetta, Kathleen Stratton, Carol Mcginnis, Gil Hardy, Theodoric Wong, Diego Arenas, Mary Pat Turon-Findley, Rubén Gustavo Kliger, Kelly Green Corkins, Jay Mirtallo, Teruyoshi Amagai, Peggi Guenter

Risultato della ricerca: Contributo in rivistaArticolo in rivista


The American Society for Parenteral and Enteral Nutrition (ASPEN) Position Paper focus is on applying the 4 ethical principles for clinician's decision-making in the use of artificially administered nutrition and hydration (AANH) for adult and pediatric patients. These basic principles are (1) autonomy, respect the patient's healthcare preferences; (2) beneficence, provide healthcare in the best interest of the patient; (3) nonmaleficence, do no harm; and (4) justice, provide all individuals a fair and appropriate distribution of healthcare resources. Preventing and resolving ethical dilemmas is addressed, with an emphasis on a collaborative, interdisciplinary approach. Optimizing early communication and promoting advance care planning, involving completion of an advance directive, including designation of a surrogate decision-maker, are encouraged. Clinicians achieve respect for autonomy when they incorporate the patient, family, community, country, geographical, and presumed cultural values and religious belief considerations into ethical decision-making for adults and children with a shared decision-making process. These discussions should be guided by the 4 ethical principles. Hospital committees and teams, limited-time trials, clinician obligation with conflicts, and forgoing of AANH are addressed. Specific patient conditions are addressed because of the concern for potential ethical issues: coma, decreased consciousness, and dementia; advanced dementia; cancer; eating disorders; and end-stage disease/terminal illness. Incorporated in the Position Paper are ethical decisions during a pandemic and a legal summary involving ethical issues. International authors presented the similarities and differences within their own country or region and compared them with the US perspective.
Lingua originaleEnglish
pagine (da-a)254-267
Numero di pagine14
RivistaNutrition in Clinical Practice
Stato di pubblicazionePubblicato - 2021
Pubblicato esternamente


  • enteral nutrition
  • parenteral nutrition
  • nutrition support
  • ethics


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