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Nutrition and Hydration in Healthcare: Bioethical Considerations and Clinical Practices

Nutrition and Hydration in Healthcare: Bioethical Considerations and Clinical Practices

Nutrition and Hydration in Healthcare: Bioethical Considerations and Clinical Practices

  1. Cure/care: compare and contrast.
  2. Basic care: Nutrition, hydration, shelter, human interaction.
    • Are we morally obliged to this? Why? Example
  3. Swallow test, describe; when is it indicated?
  4. When is medically assisted N/H indicated?
    • Briefly describe Enteral Nutrition (EN), including:
      • NJ tube
      • NG tube
      • PEG
    • Briefly describe Parenteral Nutrition (PN), including:
      • a. Total parenteral nutrition
      • b. Partial parenteral nutrition
  5. Bioethical analysis of N/H; state the basic principle and briefly describe the two exceptions.
  6. Case Study: Terry Schiavo (EXCEL FILE on Module 7: Lecture Materials & Resources page). Provide a bioethical analysis of her case; should we continue with the PEG or not? Why yes or why not?
  7. Read and summarize ERD paragraphs #:  32, 33, 34, 56, 57, 58.


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Cure vs. Care:
Cure focuses on treating the underlying cause of a disease or condition to eliminate it, while care involves providing support, comfort, and symptom management to improve the patient’s quality of life. While cure aims for a definitive solution, care emphasizes holistic well-being and may continue even when cure is not possible.

Basic Care:
Basic care includes meeting the fundamental needs of patients, such as providing nutrition, hydration, shelter, and human interaction. We are morally obliged to provide basic care because it upholds the dignity and rights of individuals and fulfills our duty to alleviate suffering. For example, neglecting to provide food and water to a bedridden patient would violate their right to live with dignity and could result in serious harm or death.

Swallow Test:
The swallow test, also known as the bedside swallow evaluation, is indicated when there is concern about a patient’s ability to swallow safely. During the test, the patient is asked to swallow various consistencies of food and liquids while the clinician observes for signs of aspiration or difficulty swallowing. It helps determine if the patient can safely consume oral nutrition and hydration without risking aspiration pneumonia.

Medically Assisted Nutrition and Hydration (N/H):
Medically assisted N/H is indicated when a patient is unable to meet their nutritional and hydration needs orally due to conditions such as dysphagia, neurological disorders, or critical illness. It may involve enteral nutrition (EN) or parenteral nutrition (PN), depending on the patient’s condition and gastrointestinal function.

Enteral Nutrition (EN):
EN involves delivering nutrition directly into the gastrointestinal tract through a tube. Common types include nasojejunal (NJ) tube, nasogastric (NG) tube, and percutaneous endoscopic gastrostomy (PEG) tube. These tubes bypass the mouth and esophagus to deliver nutrients directly into the stomach or small intestine.

Parenteral Nutrition (PN):
PN involves delivering nutrition intravenously when the gastrointestinal tract is unable to absorb nutrients adequately. It includes total parenteral nutrition (TPN), which provides all essential nutrients, and partial parenteral nutrition (PPN), which supplements oral or enteral nutrition.

Bioethical Analysis of N/H:
The basic principle guiding decisions about N/H is the principle of beneficence, which obliges healthcare providers to act in the best interests of patients. Exceptions include when N/H is futile or excessively burdensome for the patient, as determined through careful evaluation of the patient’s condition and goals of care.

Case Study: Terry Schiavo:
In Terry Schiavo’s case, the decision to continue or discontinue PEG feeding depends on whether it aligns with her previously expressed wishes and best interests. Bioethical analysis should consider factors such as prognosis, quality of life, and the patient’s values and preferences to determine the most appropriate course of action.


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