Ethical Commentary: The Ethical Acceptability of Discontinuing Artificial Nutrition and Hydration for Patients in a Permanent Vegetative State

Author(s):  
Eric Racine ◽  
Catherine Rodrigue ◽  
James L. Bernat ◽  
Richard Riopelle ◽  
Sam D. Shemie

AbstractThe care of chronically unconscious patients raises vexing medical, ethical, and social questions concerning diagnosis, prognosis, communication with family members, and decision making, including the withdrawal of life support. We provide updates on major controversies surrounding disorders of consciousness. Issues such as withdrawal of artificial nutrition and hydration – which had been considered “settled” by many in the medical, legal and ethical communities – have resurfaced under the pressure of social groups and religious authorities. Some assumptions about the level of awareness and the prognosis of vegetative state and minimal conscious patients are questioned by advances in clinical care because of insights produced by neuroscience research techniques, particularly functional neuroimaging. Both the clinical and neuroscience dimensions of disorders of consciousness raise complex issues such as resource allocation and high levels of diagnostic inaccuracies (at least, for the vegetative state). We conclude by highlighting areas needing further research and collaboration.


2020 ◽  
Vol 87 (2) ◽  
pp. 122-130
Author(s):  
John J. Raphael ◽  
Michael A. Vacca ◽  
Annmarie Hosie ◽  
Natalie Rodden ◽  
Ashley K. Fernandes ◽  
...  

There is much confusion surrounding how to interpret provision of artificial nutrition and hydration (ANH) at the bedside in complicated clinical circumstances. The specific scenario that prompted these questions was a request by a patient and her family to remove a feeding tube that had become, in the patient’s eyes and opinion, disproportionately burdensome in her particular set of clinical circumstances. This clinically relevant article can be viewed as a bedside interpretation of Catholic bioethical teachings on provision of ANH to the dying patient. Please note that this article does not address specific ethical issues that pertain to persistent vegetative state, which is beyond the scope of this particular discussion.


2010 ◽  
Vol 59 (5) ◽  
Author(s):  
Daniele De Luca ◽  
Andrea Virdis ◽  
Maria Luisa Di Pietro

All’interno dell’ampio quadro assistenziale della persona in stato vegetativo (SV), alimentazione e idratazione artificiale rappresentano un aspetto di fondamentale importanza, similmente a quanto accade nell’ambito dell’assistenza rivolta a neonati e più in generale a lattanti. Poiché spesso l’assenza di funzioni fisiologiche o di relazione con l’esterno vengono addotte per giustificare l’interruzione delle procedure assistenziali nelle persone in SV, l’articolo intende affrontare la questione della doverosità dell’idratazione e della alimentazione artificiale in tali persone, attraverso un confronto fra le diverse “funzioni” vitali, fisiologiche o comportamentali e relazionali presenti sia nei soggetti in SV sia nei neonati e nei lattanti. Alla luce di tale confronto, si evince come la sola ragione per cui possa essere erroneamente sostenuta la liceità dell’interruzione della alimentazione nei soggetti in SV è di natura ideologica e non scientifica. ---------- Within the broad framework of the care for the person in vegetative state (VS), artificial nutrition and hydration have a fundamental importance, similarly to what happens in the assistance given to newborns and to unweaned infants. As the absence of physiological functions or relationships with the outside world are often given to justify the assistance withdrawal in subjects in VS, the article aims to address the issue of artificial nutrition and hydration dutifulness in these persons, through a comparison between the various vital, physiological “functions”or behavioral and social skills present both in the subject in VS and in newborns and infants. By the light of this comparison, it appears that the only reason that can wrongly support the legality of the nutrition withdrawal in the subjects in VS is ideological and not scientific.


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