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 Monitoring the heart's mitochondria to predict cardiac arrest?
21.09.2017 | Boston Children's Hospital

nachricht Highly precise wiring in the Cerebral Cortex
21.09.2017 | Max-Planck-Institut für Hirnforschung

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: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

Im Focus: Fast, convenient & standardized: New lab innovation for automated tissue engineering & drug

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems Holding GmbH about commercial use of a multi-well tissue plate for automated and reliable tissue engineering & drug testing.

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Comet or asteroid? Hubble discovers that a unique object is a binary

21.09.2017 | Physics and Astronomy

Cnidarians remotely control bacteria

21.09.2017 | Life Sciences

Monitoring the heart's mitochondria to predict cardiac arrest?

21.09.2017 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>