Decision-Making in Artificial Nutrition and Hydration: Ethical and Legal Considerations for Minors and Incapable Patients
Keywords:
artificial nutrition and hydration, bioethics, ethical considerations, medical decisio-making, patient autonomyAbstract
The complex issues surrounding the administration of Artificial Nutrition and Hydration (ANH) in
cases involving minors or individuals incapable of understanding and willing are examined,
focusing on who should make the relevant decisions and the ethical, deontological, and legal
aspects involved. Challenges in obtaining informed consent from minors and incapable individuals
are highlighted, emphasizing the importance of considering the best interest of the patient.
Advocating for a therapeutic alliance, the involvement of the minor, the guardian, and the physician
in the decision-making process is recommended to ensure the patient's rights and dignity are
respected. The need for a multidisciplinary approach in evaluating the benefits and risks of ANH is
addressed, stressing the principles of proportionality and beneficiality to prevent unnecessary
suffering. The role of the healthcare provider in navigating these ethical dilemmas and the
importance of collaboration among medical staff, legal guardians, and families are underscored to
ensure ethically and clinically appropriate care.
References
1. Young J, Fawcett T. Artificial nutrition in older people with dementia: moral and ethical dilemmas. Nurs Older People 2002:19–21.
2. 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.
3. Karaboue M, Casella GL, Karaboue K, Cipolloni L, Bosco MA, De Simone S. Il dibattito in bioetica - Health and disease: a multicultural dichotomy. Med Morale 2023;72(2):207-212.
4. Cardenas D. Ethical issues and dilemmas in artificial nutrition and hydration. Clin Nutr 2021;23–29.
5. De Luca L, Veneziano FA, Karaboue M. Late presenters with ST-elevation myocardial infarction. Karaboue K. Nutrition: central practice in patient care. Progr Nutr 2023;25(3):e2023054. doi: 10.23751/pn.v25i3.14596.
6. Coe S, Williams R. Hydration and health. Nutr Bull 2011;259–66.
7. Karaboue K, Berritto D, Lacasella GV. Biological existence from medicalisation to biomedicalization. Clin Ter 2024;175(5):262-264. doi: 10.7417/CT.2024.5128.
8. Cioffi A, Cecannecchia C, Baldari B, Karaboue MAA. Informal caregivers in Italy: the 'phantom zone' of welfare. Acta Biomed 2023;94(1):e2023018.
9. Tollefsen C. Ten errors regarding end of life issues, and especially artificial nutrition and hydration. Philos Med, Springer Netherlands;213–26.
10. Sitges-Serra A. Brain injury, intestinal malaise and artificial nutrition. Nutr 1997;xviii–xix.
11. Karaboue MAA, Massaro M, Lacasella G. Artificial nutrition and hydration: bioethical and biolegal profiles. Progr Nutr 2023;25:e2023034.
12. Lacasella GV, Karaboue K. Nutrition and hydration of patients in a persistent vegetative state. Progr Nutr 2022;24(2):e2022136. doi: 10.23751/pn.v24i4.13895.
13. Gómez-Lobo A. Quality of life and assisted nutrition. Philos Med, Springer Netherlands;103–10.
14. Bartoletti E, Lacasella GV, Karaboue K, Cavalieri L. Aesthetic medicine: towards defining its own clinical role and necessary discipline. Aesthetic Med 2024;10(1):e2024008.
15. 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):259-261. doi: 10.7417/CT.2024.5127.
16. Karaboue M, Massaro M, Karaboue K. When nutrition becomes artificial: a bioethical issue. Progr Nutr 2023;25:e2023033.
17. Cardenas D. Ethical issues and dilemmas in artificial nutrition and hydration. Clin Nutr ESPEN, Elsevier BV;2021:23–29.
18. 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):61.
19. Jeffrey D. "Water, water everywhere": artificial nutrition and hydration at the end of life. Patient-Centred Ethics and Communication at the End of Life. CRC;2018:108–16.
20. 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. Med Histor 2022;6(1).
21. Lacasella GV, Karaboue K. A short history of human nutrition from prehistory to ancient civilisations. Progr Nutr 2022;24(2):e2022135. doi: 10.23751/pn.v24i4.13896.
22. Fiorini F, Granata A, Battaglia Y, Karaboue MAA. Talking about medicine through mass media. G Ital Nefrol 2019;36(1):2019-vol1.
23. Goodhall L. Tube feeding dilemmas: can artificial nutrition and hydration be legally or ethically withheld or withdrawn? J Adv Nurs 1997;217–22.
24. Karaboue K. A brief history of menstruation. Med Histor 2024;8(1):e2024009.
25. Karaboue MAA, Ferrara M, Bertozzi G, et al. To vaccinate or not: literacy against hesitancy. Med Histor 2022;6(1):e2022014.
26. Planas M, Camilo ME. Artificial nutrition: dilemmas in decision-making. Clin Nutr 2022;4:355–61.
27. Lacasella GV, Karaboue M. Moral strangers, markets and secular bioethics according to H.T. Engelhardt. Clin Ter 2024;175(6):388-390. doi: 10.7417/CT.2024.5144.
28. Cantisani V, Iannetti G, Miele V, et al. Addendum to the sonographic medical act. J Ultrasound 2021;24(3):229-230.
29. 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(1):e2022026.
30. Karaboue K. History of the first organ transplant: blood transfusions. Med Histor 2023;7(3):e2023049.
31. Karaboue K. Dimensions of human nutrition. Progr Nutr 2023;25(3):e2023058.
32. Morena D, Delogu G, Volonnino G, Alessandrini S, Karaboue MAA, Arcangeli M. COVID-19 risk management: a survey among Italian physicians. Clin Ter 2023;174(2):167-179.
33. Karaboue K. Bioethical aspects of prenatal diagnosis. Med Histor 2023;7(3):e2023050.
34. Karaboue K. Optimizing oral health care for patients in permanent vegetative state: a multidisciplinary approach. Progr Nutr 2024;26(1):e2024011.
35. Tabadoa J. Care and covenant. Georgetown University 2023.
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