The article outlines a comprehensive guideline of ethical and legal matters to direct clinicians when using AANH on pediatric and adult patients. It also emphasizes the need to ensure that all AANH healthcare services are provided according to the ethical principles of autonomy, non-maleficence, beneficence, and justice. It also involves the need for an interdisciplinary committee to solve ethical challenges that emerge from clinical decision-making.
Several considerations may prevent and fix ethical dilemmas associated with AANH. The knowledge and regard of a patient’s religious beliefs and cultural values may assist clinicians in understanding and respecting their preferences, which may prevent unnecessary conflicts. However, if medical decisions differ with a patient’s preferences, clinicians are obliged to follow ethical guidelines as per the institution or state (Schwartz et al., 2021). Additionally, hospital committees may be used to address ethical dilemmas. These interdisciplinary teams include professionals from different departments and some community members. They offer advice, particularly in cases involving unrepresented patients with no clear preferences, advance directive, or a designated surrogate decision-maker (SDM). Ethical dilemmas involving limited-time tests, forgoing AANH, and conflicting clinician obligations should follow the ASPEN recommendations (Schwartz et al., 2021). For instance, clinicians may not offer AANH if evidence suggests that the risks outweigh the benefits. The decision to forgo AANH depends on a patient’s or SDM’s values and preferences, illness trajectory, evidence-based- medicine, and expected clinical results. If ethical conflicts cannot be addressed through a consensus, patient transfer to a more competent institution may be advised.
The ethics of AANH mainly depend on the patient population. Ethical challenges may emerge regarding maintaining or withdrawing AANH for patients with minimally responsive-state conditions, such as decreased consciousness, coma, and dementia. In such a case, it may be challenging to justify the continuance or withdrawal of AANH without consent. Goals of care that comply with a patient’s values and beliefs and SDMs may effectively offer directives on care plans for the minimally responsive-state patients (Schwartz et al., 2021). Regarding other health complications such as advanced dementia, eating disorders, cancer, and terminal diseases, advanced directives that provide healthcare depending on the patient’s preferences and best interests should be followed. Interdisciplinary committees comprising the patient’s family members and other healthcare professionals may provide insights on how to provide patient-centered care as long as it does not harm the patient.
Ethical decisions are critical during pandemics and when providing care to infants and children. In line with the principle of justice, an ethical framework ensures fair and appropriate allocation of limited resources during pandemics, such as the Covid-19. The framework should be implemented based on the input of the bioethics committee, legal advisors, administrators, and patient representatives, among other stakeholders, to ensure fairness. In all end-of-life care issues concerning children, parents decide on the appropriate care plan centered on the child’s best interests (Schwartz et al., 2021). Although some professional organizations like AAP may defend the withdrawal of treatment plans if the risks surpass the benefits, parents or appointed surrogates are the final decision-makers.
Some state and federal laws should be considered when using AANH during end-of-life care. This mainly involves the principle of informed consent, which stipulates the freedom of a patient to decline medical treatment. Clinicians should educate patients and their families regarding the risks and benefits of AANH to enable them to make informed decisions on how or if the treatment will be administered. For incapacitated patients, clinicians should follow the advance directives or consult the appointed SDM (Schwartz et al., 2021). Failure to obtain informed consent may result in grave lawsuits that could be avoided. Despite the geographical differences, international positions regarding ethics and AANH are almost similar to those of the United States. They focus on a patient’s autonomy, informed consent, and the need for an interdisciplinary team to offer evidence-based advice.
Reference
Schwartz, D., Barrocas, A., Annetta, M., Stratton, K., McGinnis, C., & Hardy, G. et al. (2021). Ethical aspects of artificially administered nutrition and hydration: An ASPEN position paper. Nutrition in Clinical Practice, 36(2), 254-267.