Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

PENN Researchers Provide New Recommendations for Use of Artificial Nutrition and Hydration in Seriously Ill Patients

19.12.2005


For two decades, doctors have followed an ethically-established agreement about the appropriate use of artificial nutrition and hydration (ANH) for patients who are seriously ill or in a persistent vegetative state. Generally, patients or their surrogates have been able to accept or refuse ANH based upon considerations that guide most treatment decisions, i.e., potential benefits, risks, burden, religious and cultural beliefs. The Terri Schiavo case – which included very open, dramatic disagreements among family members over such considerations – publicly challenged long-held agreements about ANH and caused many to question its proper use.



In response to such challenges, researchers from the University of Pennsylvania’s Institute on Aging and Center for Bioethics, and the Philadelphia VA’s Center for Health Equity Research and Promotion review and clarify ethical principles regarding the use of ANH. According to the authors, the five ethical principles that should guide decisions about ANH are:

  • Decisions about the use of ANH should be made in the same way that decisions about other medical treatment are made.
  • The same ethical reasoning applies whether withholding or withdrawing ANH.
  • Decisions on the patient’s behalf require the same evidence of the patient’s preferences as is required for other significant treatment decisions.
  • Decisions about ANH may be made without any evidence of the patient’s preferences.
  • All Patients should receive high quality palliative care regardless of whether they receive ANH.

These recommendations are the result of a national conference held at the University of Pennsylvania in early 2005, and appear in the December 15th, 2005 issue of the New England Journal of Medicine.

“Re-examining the guiding principles of decisions to use ANH right now is essential.” asserts David Casarett, MA, MD, Assistant Professor of Geriatrics, University of Pennsylvania School of Medicine, and an investigator with the VA Center for Health Equity Research and Promotion. “It is not possible to prevent all disagreements about difficult decisions at the end of life. I guarantee that there will be another Schiavo case, or something very similar. But it is possible, and indeed it is essential, to clearly articulate the principles that should underlie decisions about ANH and to ensure that these principles guide decisions in clinical practice. Our paper was inspired by the Schiavo case,” says Casarett. “That case was the ethical equivalent of an airplane crash—a highly visible tragedy that spurs investigation, analysis, and hopefully improvements and safeguards to prevent a recurrence.”


Casarett and colleagues Jennifer Kapo, MD, Assistant Professor of Geriatric Medicine, and Arthur Caplan, PhD, Director of Penn’s Center for Bioethics, argue that because ANH is associated with uncertain benefits and significant risks, it is essential to ensure that decisions are consistent with the patient’s medical condition, prognosis, and goals for care. According to Casarett, “Artificial nutrition is generally not the life-saving treatment that people believe it to be. Unlike food and water, ANH is a medical therapy with substantial risks and burdens, which must be administered using technical medical procedures. In addition, it has no role in palliative care, since it does not promote patient comfort or ease suffering.”

The article recommends five fundamental principles for clinicians to follow and a thorough discussion of the ethical and legal justification of the decision to use ANH. The authors also review the potential obstacles to ethical decision-making in the use of ANH, including cultural beliefs, patient education, and institutional financial and regulatory pressure that might affect the care that patients receive.

“The real tragedy of the Terri Schiavo’s death” Casarett says, “was not that her family disagreed about her treatment, but rather that our politicians inserted themselves into that disagreement, like unwelcome neighbors at a private family gathering. A patient’s and family’s right to make independent decisions about ANH and other medical treatment should be defended against legal, financial, and administrative challenges at the bedside,” says Casarett. “Compassionate, ethically sound, and clinically reasonable efforts to facilitate decisions about ANH need to be part of a larger agenda to improve care for all patients with serious illness.”

Olivia Fermano | EurekAlert!
Further information:
http://www.uphs.upenn.edu

More articles from Health and Medicine:

nachricht Biofilm discovery suggests new way to prevent dangerous infections
23.05.2017 | University of Texas at Austin

nachricht Another reason to exercise: Burning bone fat -- a key to better bone health
19.05.2017 | University of North Carolina Health Care

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: New Method of Characterizing Graphene

Scientists have developed a new method of characterizing graphene’s properties without applying disruptive electrical contacts, allowing them to investigate both the resistance and quantum capacitance of graphene and other two-dimensional materials. Researchers from the Swiss Nanoscience Institute and the University of Basel’s Department of Physics reported their findings in the journal Physical Review Applied.

Graphene consists of a single layer of carbon atoms. It is transparent, harder than diamond and stronger than steel, yet flexible, and a significantly better...

Im Focus: Strathclyde-led research develops world's highest gain high-power laser amplifier

The world's highest gain high power laser amplifier - by many orders of magnitude - has been developed in research led at the University of Strathclyde.

The researchers demonstrated the feasibility of using plasma to amplify short laser pulses of picojoule-level energy up to 100 millijoules, which is a 'gain'...

Im Focus: Can the immune system be boosted against Staphylococcus aureus by delivery of messenger RNA?

Staphylococcus aureus is a feared pathogen (MRSA, multi-resistant S. aureus) due to frequent resistances against many antibiotics, especially in hospital infections. Researchers at the Paul-Ehrlich-Institut have identified immunological processes that prevent a successful immune response directed against the pathogenic agent. The delivery of bacterial proteins with RNA adjuvant or messenger RNA (mRNA) into immune cells allows the re-direction of the immune response towards an active defense against S. aureus. This could be of significant importance for the development of an effective vaccine. PLOS Pathogens has published these research results online on 25 May 2017.

Staphylococcus aureus (S. aureus) is a bacterium that colonizes by far more than half of the skin and the mucosa of adults, usually without causing infections....

Im Focus: A quantum walk of photons

Physicists from the University of Würzburg are capable of generating identical looking single light particles at the push of a button. Two new studies now demonstrate the potential this method holds.

The quantum computer has fuelled the imagination of scientists for decades: It is based on fundamentally different phenomena than a conventional computer....

Im Focus: Turmoil in sluggish electrons’ existence

An international team of physicists has monitored the scattering behaviour of electrons in a non-conducting material in real-time. Their insights could be beneficial for radiotherapy.

We can refer to electrons in non-conducting materials as ‘sluggish’. Typically, they remain fixed in a location, deep inside an atomic composite. It is hence...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Marine Conservation: IASS Contributes to UN Ocean Conference in New York on 5-9 June

24.05.2017 | Event News

AWK Aachen Machine Tool Colloquium 2017: Internet of Production for Agile Enterprises

23.05.2017 | Event News

Dortmund MST Conference presents Individualized Healthcare Solutions with micro and nanotechnology

22.05.2017 | Event News

 
Latest News

3D printer inks from the woods

30.05.2017 | Life Sciences

How circadian clocks communicate with each other

30.05.2017 | Life Sciences

Graphene and quantum dots put in motion a CMOS-integrated camera that can see the invisible

30.05.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>