Ethical and Legal Issues in Feeding and Hydration: Updated Position of Academy of Nutrition and Dietetics
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CHICAGO – All people have the right to request or refuse being fed as part of their medical treatment. Thus, health care providers and consumers should know more about the legal and ethical issues of feeding, especially among people with dementia, coma or terminal illness, according to a newly updated position paper of the Academy of Nutrition and Dietetics.
The paper emphasizes that registered dietitians, through their education and experience, know that the basis for ethical deliberation involving nutritional recommendations "includes understanding the cultural, social, psychological and spiritual needs of the individual."
The Academy's position paper "Ethical and Legal Issues in Feeding and Hydration" has been published in the June Journal of the Academy of Nutrition and Dietetics and can be found on the Academy's website. It states:
It is the position of the Academy of Nutrition and Dietetics that individuals have the right to request or refuse nutrition and hydration as medical treatment. Registered dietitians should work collaboratively as part of the interprofessional team to make recommendations on providing, withdrawing or withholding nutrition and hydration in individual cases and serve as active members of institutional ethics committees.
According to the Academy"s position paper: "When a conflict arises, the decision requires ethical deliberation. RDs' understanding of nutrition and hydration within the context of nutritional requirements and cultural, social, psychological and spiritual needs provide an essential basis for ethical deliberation."
Accompanying the Academy's position paper is a new practice paper to assist registered dietitians (or registered dietitian nutritionists) in putting recommendations of the position paper to use with patients and clients. Practice papers are published on the Academy's website for members and are available to the public for purchase.
The authors of the Academy's position and practice papers encourage everyone – consumers and health professionals alike – to become familiar with the many patient rights issues that can arise when providing feeding in health-care settings. They include:
- Request or refuse feeding: It is your right.
- As part of an advanced directive or durable power of attorney, express your preferences about food and nutrients.
- Know that all goals and decisions involving feeding and hydration are individualized.
- For nutrition professionals, understand the legal issues concerning end-of-life feeding and hydration.
The Academy's position paper was written by registered dietitians Julie O’Sullivan Maillet, PhD, RD, FADA, professor and interim dean at the University of Medicine and Dentistry of New Jersey School of Health Related Professions; Denise Baird Schwartz, MS, RD, FADA, CNSC, nutrition support coordinator at Providence Saint Joseph Medical Center, Burbank, Calif.; and Mary Ellen Posthauer, RD, CD, LD, president of MEP Healthcare Dietary Services, Inc., Evansville, Ind.
The Academy's practice paper was written by Denise Baird Schwartz, MS, RD, FADA, CNSC, nutrition support coordinator at Providence Saint Joseph Medical Center, Burbank, Calif.; Mary Ellen Posthauer, RD, CD, LD, president of MEP Healthcare Dietary Service, Inc., Evansville, Ind.; Julie O'Sullivan Maillet, PhD, RD, FADA, professor and interim dean at the University of Medicine and Dentistry of New Jersey School of Health Related Professions, Newark, NJ.
All registered dietitians are nutritionists – but not all nutritionists are registered dietitians. The Academy’s Board of Directors and Commission on Dietetic Registration have determined that those who hold the credential registered dietitian (RD) may optionally use “registered dietitian nutritionist” (RDN) instead. The two credentials have identical meanings.
The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) is the world’s largest organization of food and nutrition professionals. The Academy is committed to improving the nation’s health and advancing the profession of dietetics through research, education and advocacy.