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Ethical Aspects of Artificially Administered Nutrition and Hydration: An ASPEN Position Paper.

  • Schwartz, Denise Baird1
  • Barrocas, Albert2
  • Annetta, Maria Giuseppina3
  • Stratton, Kathleen4
  • McGinnis, Carol5
  • Hardy, Gil6
  • Wong, Theodoric7
  • Arenas, Diego8
  • Turon-Findley, Mary Pat9
  • Kliger, Rubén Gustavo10
  • Corkins, Kelly Green11
  • Mirtallo, Jay12
  • Amagai, Teruyoshi13
  • Guenter, Peggi14
  • 1 Bioethics Committee Community Member, Providence Saint Joseph Medical Center, Burbank, California, USA.
  • 2 Tulane University School of Medicine, New Orleans, Louisiana, USA.
  • 3 Fondazione Policlinico Gemelli Hospital - Catholic University, Rome, Italy. , (Italy)
  • 4 Clinical Nutrition Support Services and the Penn Lung Transplant Institute, Hospital Ethics Committee, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • 5 Sanford Health, Sioux Falls, South Dakota, USA.
  • 6 Clinical Nutrition, Auckland, New Zealand. , (New Zealand)
  • 7 Women's and Children's Hospital, Birmingham, United Kingdom. , (United Kingdom)
  • 8 Direccion Medicina Functional y Nutricion Clinica, Zapopan, Jalisco, Mexico. , (Mexico)
  • 9 Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
  • 10 Nutrition Service and Nutritional Support Unit, Austral University Hospital, Buenos Aires, Argentina. , (Argentina)
  • 11 LeBonheur Children's Hospital, Memphis, Tennessee, USA.
  • 12 College of Pharmacy, The Ohio State University, Columbus, Ohio, USA.
  • 13 Mukogawa Women's University, Nishinomiya, Hyogo, Japan. , (Japan)
  • 14 Clinical Practice Quality and Advocacy, American Society for Parenteral and Enteral Nutrition (ASPEN).
Published Article
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
Publication Date
Feb 22, 2021
DOI: 10.1002/ncp.10633
PMID: 33616284


The American Society for Parenteral and Enteral Nutrition (ASPEN) Position Paper focus is on applying the 4 ethical principles for clinician's decision-making in the use of artificially administered nutrition and hydration (AANH) for adult and pediatric patients. These basic principles are (1) autonomy, respect the patient's healthcare preferences; (2) beneficence, provide healthcare in the best interest of the patient; (3) nonmaleficence, do no harm; and (4) justice, provide all individuals a fair and appropriate distribution of healthcare resources. Preventing and resolving ethical dilemmas is addressed, with an emphasis on a collaborative, interdisciplinary approach. Optimizing early communication and promoting advance care planning, involving completion of an advance directive, including designation of a surrogate decision-maker, are encouraged. Clinicians achieve respect for autonomy when they incorporate the patient, family, community, country, geographical, and presumed cultural values and religious belief considerations into ethical decision-making for adults and children with a shared decision-making process. These discussions should be guided by the 4 ethical principles. Hospital committees and teams, limited-time trials, clinician obligation with conflicts, and forgoing of AANH are addressed. Specific patient conditions are addressed because of the concern for potential ethical issues: coma, decreased consciousness, and dementia; advanced dementia; cancer; eating disorders; and end-stage disease/terminal illness. Incorporated in the Position Paper are ethical decisions during a pandemic and a legal summary involving ethical issues. International authors presented the similarities and differences within their own country or region and compared them with the US perspective. © 2021 American Society for Parenteral and Enteral Nutrition.

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