Rothaermel S, Bischoff S C, Bockenheimer-Lucius G, Frewer A, Wehkamp K H, Zuercher G
Institute for Biological, Health and Medical Law, University of Augsburg, Germany.
Ger Med Sci. 2009 Nov 18;7:Doc16. doi: 10.3205/000075.
Adequate nutrition is a part of medical treatment and is influenced by ethical and legal considerations. Patients, who cannot be sufficiently fed via the gastrointestinal tract, have the fundamental right to receive PN (parenteral nutrition) even so patients who are unable to give their consent. General objectives in nutrition support are to supply adequate nutrition with regards to the prevention of malnutrition and its consequences (increased morbidity and mortality), and thereby promoting improved outcome and/or quality of life for the patient considering always the patient's needs and wishes. The requests of the patient to renounce PN should be respected where a signed living will is helpful. During the course of a terminal illness the nutrition has to be adapted individually according to the needs and wishes of a patient in the corresponding phase. Capability of consent should be checked in each individual case and for each measure on an individual basis. Consent should only be accepted if the patient is capable of recognizing the nature, meaning and importance of the intervention as well as the consequences of relinquishment of such an intervention, and is capable to make a self-determined decision. If the patient is not capable of consenting, the patient's living will is the most important document when determining their assumed will and legally binding. Otherwise a guardian appointed by the patient, or the representative appointed by the court (if the patient has made no provisions) can make the decision.
充足的营养是医疗治疗的一部分，并受到伦理和法律考量的影响。即使是无法表达同意的患者，那些不能通过胃肠道获得足够喂养的患者也有接受肠外营养（PN）的基本权利。营养支持的总体目标是提供充足的营养，以预防营养不良及其后果（发病率和死亡率增加），从而考虑到患者的需求和意愿，促进患者改善预后和/或生活质量。如果有签署的生前预嘱，患者放弃肠外营养的请求应得到尊重。在终末期疾病过程中，营养必须根据患者在相应阶段的需求和意愿进行个体化调整。应针对每个病例和每项措施逐一检查同意能力。仅当患者能够认识到干预的性质、意义和重要性以及放弃此类干预的后果，并且能够做出自主决定时，才能接受其同意。如果患者无同意能力，在确定其假定意愿时，患者的生前预嘱是最重要的文件且具有法律约束力。否则，由患者指定的监护人或法院指定的代表（如果患者未作安排）可以做出决定。
