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:
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.”
Olivia Fermano | EurekAlert!
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