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The National Catholic Bioethics Center
American Nurses Association on Palliative Care
December 1, 2016
© 2017 by The National Catholic Bioethics Center


NCBC Recommends Public Comment on the Draft Proposal on Palliative Care of the American Nurses Association

The American Nurses Association has written a draft proposal on Nutrition and Hydration at the End of Life (http://bit.ly/2fl359x).

Please provide comment by December 1, 2016, concerning the damage that will be done to the profession of nursing, and to the patients, if such a proposal is adopted: (http://bit.ly/2fl359x). Some concerns follow:

This proposal makes broad generalizations about the withholding of nutrition and hydration. Despite statistical reports about the overall benefit, or lack of benefit, of assisted nutrition and hydration in some cases at the end of life, all cases are case specific, and need to be assessed as such, to determine if assisted nutrition and hydration are proportionately beneficial. Furthermore, there is insufficient data to categorically conclude that patents deprived of nutrition and hydration do not feel the symptoms of that deprivation. If this were true, there would be no need to offer palliation, such as sedation, to these patients.

Furthermore, the case of patients Voluntary Stopping of Eating and Drinking (VSED) presents a unique ethical dilemma for the health care provider. What is clear is that while one cannot force feed a patient, legal interventions to determine competency, as well as abuse, need to be initiated in the case VSED. If it is determined that the patient truly has consented to withholding oral feedings that can be assimilated without causing disproportionately harmful side effects, the nurse, and other health care providers, should not cooperate in this direct intention to purposely end one’s life, for example by providing sedation to diminish the sense of deprivation. At the same time all basic care critical to the patient’s wellbeing should be provided by the health care provider, as he or she continues to try to encourage physiologically beneficial nutrition and hydration.

While no competent patient should be force fed, health care providers should refuse to participate in such a VSED plan. Basic care never is to be denied a patient, regardless of the decisions patients make. However, autonomy is not limitless, especially if it violates the autonomy of others. Thus no health care provider should be forced to participate in the care of a patient engaged in VSED or who is being denied, even with consent, proportionately beneficial assisted nutrition and hydration.