Carilion Clinic, Department of Surgery, Virginia Tech Carilion School of Medicine, 1906 Belleview Ave., Roanoke, VA, 24014, USA.
Carilion Clinic Palliative Medicine, Virginia Tech Carilion School of Medicine, 1906 Belleview Ave, Roanoke, VA, 24014, USA.
Curr Gastroenterol Rep. 2023 Mar;25(3):69-74. doi: 10.1007/s11894-023-00862-z. Epub 2023 Mar 2.
Provide an evidence-based resource to inform ethically sound recommendations regarding end of life nutrition therapy.
• Some patients with a reasonable performance status can temporarily benefit from medically administered nutrition and hydration(MANH) at the end of life. • MANH is contraindicated in advanced dementia. • MANH eventually becomes nonbeneficial or harmful in terms of survival, function, and comfort for all patients at end of life. • Shared decision-making is a practice based on relational autonomy, and the ethical gold standard in end of life decisions. A treatment should be offered if there is expectation of benefit, but clinicians are not obligated to offer non-beneficial treatments. A decision to proceed or not should be based on the patient's values and preferences, a discussion of all potential outcomes, prognosis for given outcomes taking into consideration disease trajectory and functional status, and physician guidance provided in the form of a recommendation.
提供循证资源，为临终营养治疗提供合理的伦理建议。
一些身体状况较好的患者在临终前可暂时受益于医疗提供的营养和水合（MANH）。
中晚期痴呆患者禁忌使用 MANH。
从生存、功能和临终舒适度方面来看，MANH 对所有患者最终都没有益处，甚至有害。
共享决策是一种基于关系自主权的实践，是临终决策的伦理金标准。如果有预期的获益，就应该提供治疗，但临床医生没有义务提供无益的治疗。是否继续治疗应基于患者的价值观和偏好，讨论所有潜在的结果，根据疾病轨迹和功能状态预测给定结果的预后，并以建议的形式提供医生的指导。
