Balancing autonomy and care: The ethical and legal dilemmas of artificial nutrition and hydration under compulsory health treatment
Keywords:
Artificial Nutrition and Hydration , Bioethics, Compulsory Health Treatment, Eating Disorders, Patient AutonomyAbstract
The complex issue of informed consent in the context of administering Artificial Nutrition and Hydration (ANH) under Compulsory Health Treatment (TSO) is explored, examining whether ANH can be forcibly administered, particularly in cases involving patients with eating disorders such as severe anorexia. The tension between respecting patient autonomy and the medical duty to provide care, especially when the patient cannot give valid consent, is highlighted. While TSO represents a significant limitation on personal freedom, it must be justified only under extreme clinical conditions, with the patient’s informed consent being paramount whenever possible. Advocacy for a therapeutic alliance and empathetic-supportive approach is emphasized, stressing the importance of non-coercive methods and respecting patient self-determination. Additionally, a multidisciplinary approach in decision-making is underscored, involving ethicists, legal experts, and family members to ensure that decisions align with the patient’s best interests and uphold their dignity and autonomy.
References
1. Battimelli G. Nutrizione ed idratazione artificiale (NIA) nei documenti di alcune società scientifiche: una riflessione bioetica. Medicina e Morale 2011;3.
2. Lacasella GV, Karaboue K. Nutrition and hydration of patients in a persistent vegetative state. Prog Nutr 2022;24(2):e2022136. doi: 10.23751/pn.v24i4.13895
3. Karaboue K. Optimizing oral health care for patients in permanent vegetative state: a multidisciplinary approach. Prog Nutr 2024;26(1):e2024011.
4. Gabriel MS, Tschanz JA. Artificial nutrition and hydration. In: Oxford textbook of palliative nursing. Oxford University Press; 2015. p. 237–46.
5. Lacasella GV, Karaboue K. A short history of human nutrition from prehistory to ancient civilisations. Prog Nutr 2022;24(2):e2022135. doi: 10.23751/pn.v24i4.13896
6. Mercé P, Camilo ME. Artificial nutrition: dilemmas in decision making. Clin Nutr 2002;355–61.
7. Karaboue MAA, Massaro M, Lacasella G. Artificial nutrition and hydration: bioethical and biolegal profiles. Prog Nutr 2023;25:e2023034.
8. Bozzetti F, Allison S. Ethical and legal aspects of home parenteral nutrition. In: Home parenteral nutrition. 2006. p. 355–63.
9. De Luca L, Veneziano FA, Karaboue M. Late presenters with ST elevation myocardial infarction: a call to action. J Clin Med 2022;11(17):5169.
10. Karaboue MAA, Massaro M, Lacasella G. Artificial nutrition and hydration: bioethical and biolegal profiles. Prog Nutr 2023;25(2):e2023034. doi: 10.23751/pn.v25i2.14592
11. Karaboue K. A brief history of menstruation. Medicina Historica 2024;8(1):e2024009.
12. Cappabianca P, Russo GM, Atripaldi U, et al. Universal access to advanced imaging and healthcare protection: UHC and diagnostic imaging. Med Sci (Basel) 2021;9(4):4.
13. Sessa F, Esposito M, Cocimano G, Sablone S, Karaboue MAA, Chisari M, et al. Artificial intelligence and forensic genetics: current applications and future perspectives. Appl Sci 2024;14(5):2113. doi: 10.3390/app14052113
14. Fiorelli A, Accardo M, Carelli C, et al. Harmonic technology versus neodymium doped yttrium aluminium garnet laser and electrocautery for lung metastasectomy: an experimental study. Interact Cardiovasc Thorac Surg 2016;23(1):47–56.
15. Pironi L. Development of home artificial nutrition in Italy over a seven year period: 2005–2012. BMC Nutr 2017;3(6).
16. Karaboue K. Nutrition: central practice in patient care. Prog Nutr 2023;25(3):e2023054. doi: 10.23751/pn.v25i3.14596
17. Torchia J. Artificial hydration and nutrition for the PVS patient. Natl Cathol Bioeth Q 2003;3(4):719–30.
18. Scalera A. Brevi note su dichiarazioni anticipate di trattamento e alimentazione o idratazione artificiale. Questione Giustizia 2010;1:81–89.
19. Karaboue K, Berritto D, Lacasella GV. Biological existence from medicalisation to biomedicalization. Clin Ter 2024;175(5):262–64. doi: 10.7417/CT.2024.5128
20. Cardenas D. Ethical issues and dilemmas in artificial nutrition and hydration. Clin Nutr ESPEN 2021;23–29.
21. Karaboue M, Casella GL, Karaboue K, Cipolloni L, Bosco MA, De Simone S. Il dibattito in bioetica. Medicina e Morale 2023;72(2):207–12.
22. Ackermann RJ. Withholding and withdrawing life sustaining treatment. Am Fam Physician 2000;62(7):1555–60, 1562, 1564.
23. Cioffi A, Cecannecchia C, Baldari B, Karaboue MAA. Informal caregivers in Italy: the ‘phantom zone’ of welfare. Acta Biomed 2023;94(1):e2023018.
24. Lesi C, Fabozzi MT, Valeriani L, Zoni L. Nutrizione artificiale e aspetti di bioetica: terapia medica o assistenza di base? Ital J Med 4(1):63–69.
25. Karaboue M, Massaro M, Karaboue K. When nutrition becomes artificial: a bioethical issue. Prog Nutr 2023;25:e2023033.
26. Mayo T. Forgoing artificial nutrition and hydration: legal and ethical considerations. Nutr Clin Pract 1996;11(6):254–64.
27. Bartoletti E, Lacasella GV, Karaboue K, Cavalieri L. Aesthetic medicine: towards defining its own clinical roland necessary discipline. Aesthetic Med 2024;10(1):e2024008.
28. Szaniszlo IMV. Some considerations about ethical dilemmas of artificial nutrition and hydration of patients in a persistent vegetative state from the Christian perspective. Ann Bioethics 2020.
29. Karaboue K. Bioethical aspects of prenatal diagnosis. Medicina Historica 2023;7(3):e2023050.
30. Karaboue MAA, Lacasella GV, Cecannecchia C, et al. End of life in Italy: critical and bioethical aspects of the bill on physician assisted suicide. Med Histor 2022;6:e2022026.
31. Karaboue M, Berritto D, Lacasella GV. Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation: medico legal and legal comparative study. Clin Ter 2024;175(5):259–61. doi: 10.7417/CT.2024.5127
32. Karaboue K. Dimensions of human nutrition. Prog Nutr 2023;25(3):e2023058.
33. Lacasella GV, Karaboue M. Moral strangers, markets and secular bioethics according to H T Engelhardt. Clin Ter 2024;175(6):388–90. doi: 10.7417/CT.2024.5144
34. Karaboue MAA, Milone V, Lacasella GV, et al. What will our children do when we are gone? Italian legislature does not tackle the worries of parents of disabled children. Reflections on disability. Med Histor 2022;6(1):e2022013.
35. Fiorini F, Granata A, Battaglia Y, Karaboue MAA. Talking about medicine through mass media. G Ital Nefrol 2019;36(1):2019.
36. Karaboue K. History of the first organ transplant: blood transfusions. Medicina Historica 2023;7(3):e2023049.
37. Cantisani V, Iannetti G, Miele V, et al. Addendum to the sonographic medical act. J Ultrasound 2021;24(3):229–30.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Karidia Karaboue, Giorgia Viola Lacasella, Michele Ahmed Antonio Karaboue
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
