Ethical Issues in Withholding or Withdrawal of Artificial Nutrition and Hydration

A I M : The purpose of this study was to identify and explore the main ethical dilemmas arising for a health care teamworking in a clinical nutrition unit when decisions about withholding or withdrawal of artificial nutrition and hydration(ANH) of seriously ill patients have to be made. The potential factors influencing this decision-making processare also described.M A T E R I A L - M E T H O D : Fifteen health carers working in a Clinical Nutrition Unit in the United Kingdomparticipated in the study and qualitative research methods were used to gather data.R E S U L T S : The findings of the study illustrate that withdrawal of life-sustaining nourishment is one of themost difficult ethical dilemmas for the health care professionals. The reason for such difficulty is associated with thepotential outcome of that intervention, as it brings about a patient’s death. Furthermore, quality of life issues appearto influence the decision-making process. When the patient’s voice is absent, the health care team takes into accountthe perspectives of the patient’s family, in order to decide to abate life-sustaining nourishment.C O N C L U S I O N S : By exploring the health carers’ attitudes on ethical issues and identifying their involvementin the decision-making process, an in-depth understanding of the process is provided. The ethical decision-makingprocess is not an easy task. The question of whether ANH should be ethically withdrawn seems to be very complex.Health carers should take into consideration all the factors influencing the decision-making in order to contributemore effectively to facilitate the whole process