Meeting estimated nutritional needs and providing adequate nutrition and hydration for all residents can, at times, be a difficult challenge not only for the resident but also for the interdisciplinary team. Ethical considerations of starting and stopping artificial nutrition must be considered in the best interest of the resident.

Despite the evidence outlining indications for the use of tube feedings and parenteral nutrition, some healthcare providers believe that giving tube feedings or parenteral nutrition (TPN) is a level of basic human care. Many providers believe they must always offer nutrition as an option, just as they must offer pain management and basic personal care.  However, medical providers should set aside their personal and/or religious beliefs, listen to the resident and their families, and rely on professional guidance regarding inserting feeding tubes or starting TPN and the ethics of withholding or withdrawing them.

When considering whether tube feeding or TPN is appropriate for a resident, providers should consider what can be accomplished by artificial nutrition and whether that goal is reasonable given the resident’s prognosis. Residents with a terminal illness cannot expect to change their prognosis and may be unable to prolong life or improve quality of life with the use of artificial nutrition and hydration.  It is ethical to forgo nutrition support when all concerned parties understand what can and cannot be achieved. Likewise, nutrition support is indicated for those in which the benefits outweigh the risks and when prognosis leads to quality of life.

Registered dietitians at Nutrition Care Systems are qualified to assist residents, family members, and doctors in making the decision to proceed or not with artificial nutrition and hydration.