Bioethics for Medical Nutrition and Hydration - MyAssignmenthelp

Question: Discuss about theBioethics for Medical Nutrition and Hydration. Answer: Medical nutrition and Hydration is the intervention that is developed by medical research and practice to meet the nutrition and the water needs of the patient. Withholding or withdrawing of this intervention may lead to dying of the patient due to malnutrition and dehydration (1). Medical nutrition and Hydration is given to patients in various clinical situations such as difficulty swallowing or feeding themselves, if the patient is unconscious or is permanently unresponsive or in case of advance life threatening illness or if the patient is dying (2).The essay deals with the argument that Medical nutrition and Hydration is routinely provided to the patients, including those with the post-comma unresponsiveness. In response to the argument the essay aims to critically assess the arguments for and against the withdrawal of Medical Nutrition and Hydration or MNH. Medical nutrition and Hydration is thus provided to the patient in ways other than by mouth. In patients who have lost excess fluids from the body and cannot be feeded orally there are 2 ways to replace the fluids. In such patients, fluid can be put right into a vein also called as intravenous fluid replacement. The fluid can be injected under the skin which is also called as subcutaneous fluid replacement and hypodermoclysis. In some cases a nasogastric tube is put through nose, down the throat and into the stomach (3). There are several problems associated with the MNH. During hypodermoclysis, the speed of the drip changes, the site of the insertion of needle will swell and turn painful and sometimes the blood is collected in the tube, and high risk of infection (4). These are the minor complications which are avoided due to larger benefits of MNH. For instance a person with the advanced life threatening illness may swallow the water and the nutrition needs. If this form of treatme nt is withdrawn then the patient may fall in deep sleep or comma and usually die within 3 weeks. The health care team undergo ethical and legal dilemma when making decision related to giving of the MNH (2). In many cases the people deny this treatment as it is not a medical care (1). There are negative implications associated with the withdrawal of MNH. (5) argued that the withdrawal of this form of care is dictated by the denial of unreasonable obstinacy enshrined in law and is justified by the health complications associated with the withdrawal. In various countries the reluctance in withdrawal of this treatment is due to symbolic value attached with the food and nutrition. If the hydration system is withdrawn then the patient may die badly while suffering from hunger and thirst. Fear of such implication is other factor that hinders the withdrawal of the treatment (6). Further, there is a difficult distinction between the medical act and the euthanasia which is the cause of reluctance in making such decision (7). However, such reluctance can be overcome by ensuring flawless accompaniment, appropriate comfort care and associating sedation with clear justification not only to the caregivers but also to the family members. The rationale and the implication of this type of decision should be made clear by the health care team (8). The patients undergo serious burden of pain and suffering, financial expenditure, high risk of injury and mortality. MNH is provided to the patient even during post comma unresponsiveness. However, withdrawal of treatment in such scenario is mostly demanded by the family members. It is perceived by the family member that MNH does not ensure improvement in the health related quality of life. It is perceived by the family members of the patient in comma that MNH offers no reasonable expectation of maintaining of improving health (6). MNH in case of patients in persistent vegetative state is questionable. MNH is considered morally optional in this case. It can be argued that the treatment in these patients will continue indefinitely as the patient will be permanently unconscious. It is considered waste of health care resources to prolong the life of such patients as nothing can help of harm the patient (8). This prolonged treatment makes people believe that dying is better than MNH. Therefore, withdrawal of MNH in such circumstances is considered justified and is morally requested to be removed by the patients family members. The medical ethicists are concerned about the peoples rights in case of patients in minimally conscious state and permanent vegetative state. They must consider the empirical data pertaining to this situation before applying ethical theories to medico-legal realities. Even in cases where the patient is not in the vegetative state withdrawal of MNH is preferred. According to (2) patients with stroke have severe difficulty in swallowing food and they also have altered state of consciousness. Therefore, they need artificial nutrition and hydration. By law it is a treatment and not considered as basic care. Therefore, it is mandatory for the person to receive this form of treatment else it may lead to risk of severe disabilityand very poor quality of life. In catholic communities the MNH is considered a moral obligation particularly in case of patients with the permanent unresponsiveness where the patient is neurologically incapable of feeding themselves (9). Most people feel guilty of denying nutritional substance to others when they themselves are having it. The decision of withdrawal is criticised by many researchers in this area. In most cases the criticism is the outcome of suspected intentions. In some cases the withdrawal may be requested by the family member with the intention to kill (10). It may also be requested if the family members are overburdened with the treatment cost (11). On the other hand some people perceive that it is unreasonable for the person in persistent vegetative state to be alive in undignified condition. Rather the family members believe that it is reasonable to relieve them of the burden of living (9, 10 ad 11). These suspected intentions cause decision-making by the health care professionals a very difficult process. According to (12) people prefer withdrawal of MNH even if the patient is not permanently unresponsive. In some countries the withdrawal is considered to be justified for instances England and Waless particularly in case of permanent vegetative state of patients. The withdrawal is in patients best interest and is based on judicial approval to reassure the patients families (13). In case of patients with terminal illness people perceive that MNH offers no reasonable expectation. Instead people prefer procedures that can improve the heath without creating serious burden on the patient or on the family care givers (10). If there is limited life expectancy of the person then it is justified to withdraw MNH (11). It can be morally requested to withhold MNH if the patient is unable to handle the pain and suffering associated with the artificial hydration system. However, the burden cannot be determined by the care givers or the health care professionals. It can only be determined by the pat ient followed which the health care professionals and the law can be obliged to approve withdrawal. It was argued by (12) that even if the patient is not terminally ill MNH should be morally optional considering the extreme distress caused to the person. Such situation may be possible although tragic. However, making this decision is complicated as a person has high potential to recover from non terminal illness. In this case maintaing the improving health is perceived essential y the healthcare professional (1 and 2). This decision is critical because it is difficult to find the distinction between trying to commit suicide and refusing the oral nourishment (13). This, moral dilemma cannot be resolved easily for instance if food is causing extreme distress then it is reasonable to refuse medical nutrition from the patient perspective (14). This idea is consistent with (tragic situation) leaving reasonably and taking reasonable care of our life (15). The decision to withdraw MNH from terminally ill patients is less complicated when compared to making similar decision in case of peop le in permanently vegetative state as they later cannot express their concern related to distress or refuse the treatment. In case of the patients who are in persistent vegetative state the health care professionals face moral and ethical dilemma to withhold r withdraw the MNH. It is due to various suspicious arguments put forward by the family members and relatives in this context. Withdrawal is considered to be killing by many people which leads to the argument of rights. Since everyone has the right to live, killing cannot be morally justified. These conflicts have remained unresolved since decades (10, 11 and 14). Further, an important aspect of ethical question in many situations is the quality of life is. This may be irrevalant to the moral questions about preserving life. Further, arguments against withdrawal of MNH involve needless suffering which is unreasonable (16). In case of dementia patients MNH may be more burdensome or frightening as they cannot comprehend what is happening (17). In conclusion, the review of literature from decades of research in this area concludes the decision to withdraw or withhold MNH from patients in terminal, non-terminal illness, permanently unresponsive state as indecisive. This is the outcome of various suspicious arguments in regards to MNH. These arguments are made in face of many unresolved theological issues and uncertainty of the treatment. Based on the discussion, the withdrawal of MNH may be justified to some extent in case of patients with terminal illness or fatal pathology. However, the same may not be justified for patients in the permanent vegetative state and it is still debatable if they should generally be allowed to die. It can be concluded that MNH is morally justified in case it helps a patient to achieve a good life, provided it should be given to an extent that it can be achieved. It is justified to embrace something that is least worse. It is morally unjustified if MNH does not help achieve a good life. It is re commended that the health care professionals should make decisions related to nutrition and hydration which should be guided by the presumption in favour of MNH. A decision to withdraw such treatment should be based on careful assessment of the positive and negative factors, benefits and burdens of MNH for each patient, their family and community. Withdrawn must not be done with the intention to cause death. However, it is justified if MNH offers no reasonable hope of sustaining life. It is also justified in case there are excessive risks or burdens. There is a need of developing more effective and humane mechanism for reviewing best interest decisions about MNH withdrawal from these patients. References Kitzinger C, Kitzinger J. Withdrawing artificial nutrition and hydration from minimally conscious and vegetative patients: family perspectives. Journal of medical ethics. 2015 Feb 1;41(2):157-60. 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