Wall M G, Wellman N S, Curry K R, Johnson P M
Coral Springs Medical Center, FL 33065.
J Am Diet Assoc. 1991 May;91(5):549-52.
Medical, legal, and bioethical discussions have focused on withholding or withdrawing nourishment from adults who are terminally ill or in persistent vegetative states, yet few discussions have considered the dietitian's role. In June 1990, the Supreme Court upheld an individual's right to refuse life-prolonging procedures, provided those wishes had been clearly documented. This decision, and The American Dietetic Association's 1987 guidelines for feeding the terminally ill, may enable dietitians to evaluate complicated situations regarding feeding and nonfeeding of patients. A survey sent to 590 registered dietitians in The American Dietetic Association's Nutrition Support dietetic practice group resulted in a 42% (n = 250) response rate. In general, dietitians were more willing to discontinue total parenteral nutrition than to discontinue enteral, noninvasive enteral, or oral feedings. They thought that feeding could be discontinued if it causes pain or worsens the condition, if death is imminent, or if the patient has requested that feeding be stopped. University courses and continuing education programs on the ethics and legalities of feeding terminally or critically ill adults will enable dietitians to take active roles in the decision-making process and to promote awareness of relevant issues with patients and families.
医学、法律和生物伦理方面的讨论主要集中在对身患绝症或处于持续性植物人状态的成年人停止提供或撤除营养支持上，然而很少有讨论涉及营养师的角色。1990年6月，美国最高法院支持个人拒绝延长生命程序的权利，前提是这些意愿有明确记录。这一裁决以及美国饮食协会1987年关于为绝症患者提供营养的指导方针，可能使营养师能够评估与患者营养供给和不供给相关的复杂情况。向美国饮食协会营养支持饮食实践小组的590名注册营养师进行的一项调查，得到了42%（n = 250）的回复率。总体而言，营养师更愿意停止全胃肠外营养，而不是停止肠内营养、非侵入性肠内营养或口服喂养。他们认为，如果喂养会导致疼痛或使病情恶化、死亡即将来临，或者患者要求停止喂养，那么就可以停止喂养。关于为身患绝症或重症成年人提供营养的伦理和法律问题的大学课程及继续教育项目，将使营养师能够在决策过程中发挥积极作用，并提高患者及其家属对相关问题的认识。
