Nutritional Support in the Situation of Terminal Illness: Ethical Dilemmas

The aim of this chapter is to give simple suggestions that might the help care provider in making a viable clinical decision. However, each case should be treated in an individualized manner taking into consideration the ratio between risks and benefits of this treatment. Malnutrition has been described as the imbalance between intake and requirement which results in altered metabolism, impaired function and loss of body mass or as a state of nutrition in which a deficiency or imbalance of energy, protein, and other nutrients causes measurable adverse effects on tissue and/or body form.

Regardless of the underlying sickness, palliative care is a type of treatment that aims to humanize and improve the health of patients with chronic conditions. This is because the major objective is to get a multidisciplinary care team, the patient, and the patient's family to work together. Nutrition should be viewed in these patients as a strategy that has the potential to be beneficial but also carries some risk. Therefore, its indication should be subject to a careful and continuous evaluation. Indication for hydration and artificial nutrition (HAN) is based on respect for autonomy, beneficence, non-maleficence, and justice. The quality or quantity of nutrients should not be the focus of bioethical debates surrounding artificial nutrition in terminally ill patients; rather, the debates should center on the indication and efficacy of the nutrients as well as the proper choices for their application. The multidisciplinary team and the bioethics committee of our hospitals must thoughtfully consider all forms of life support, including nourishment and hydration.

This study suggests lines of action that can serve as clinical guidance, although decision-making must always be individualized, considering the balance between risks and benefits of this treatment modality. The patient's wishes must be given top priority.