Monod S, Chiolero R, Büla C, Benaroyo L. Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Medical Center, Lausanne, Switzerland. Stefanie.Monod-Zorzi@chuv.ch. JPEN J Parenter Enteral Nutr. 2011 May;35(3):295-302. doi: 10.1177/0148607111405338.
Providing or withholding nutrition in severely disabled elderly persons is a challenging dilemma for families, health professionals, and institutions. Despite limited evidence that nutrition support improves functional status in vulnerable older persons, especially those suffering from dementia, the issue of nutrition support in this population is strongly debated. Nutrition might be considered a basic need that not only sustains life but provides comfort as well by patients and their families. Consequently, the decision to provide or withhold nutrition support during medical care is often complex and involves clinical, legal, and ethical considerations. This article proposes a guide for health professionals to appraise ethical issues related to nutrition support in severely disabled older persons. This guide is based on an 8-step process to identify the components of a situation, analyze conflicting values that result in the ethical dilemma, and eventually reach a consensus for the most relevant plan of care to implement in a specific clinical situation. A vignette is presented to illustrate the use of this guide when analyzing a clinical situation.