Clinical Nutrition Open Science (Feb 2023)
Commentary on the American Society for Parenteral and Enteral Nutrition (ASPEN) position paper: Ethical aspects of artificially administered nutrition and hydration
Abstract
Summary: “Ethics is knowing the difference between what you have a right to do and what is right to do.” -Potter Stewart.In their position paper, “Ethical Aspects of Artificially Administered Nutrition and Hydration: An ASPEN Position Paper”, [1] Schwartz et al. eloquently communicate key ethical concepts surrounding the care of patients receiving artificially administered nutrition and hydration (AANH). Ethically, all clinicians have the right and responsibility to provide nutrition-related access and resources to individuals in their care. At the same time, AANH is not always the right treatment to offer or provide.This revised position paper, published in Nutrition in Clinical Practice (NCP) in April 2021 [1], is the work of the American Society for Parenteral and Enteral Nutrition (ASPEN) International Clinical Ethics Position Paper Update Workgroup. It represents a comprehensive update of the Ethics Position Paper of the ASPEN Ethics Position Paper Task Force, published in NCP in 2010. [2] The revised position paper includes a detailed discussion of important ethical considerations not covered in the 2010 paper: cancer and AANH, eating disorders and AANH, ethical considerations raised during the COVID-19 pandemic, and an international perspective on ethics and AANH. The position paper also references the Cartagena Declaration of 2019, which “stresses the recognition that nutrition care is a human right” [1,3] and comments that “extrapolating from this document, it appears to support resource allocation in a fair, transparent and consistent fashion” [1,3].This commentary summarizes the position paper and serves as a “call to action”. All medical professionals can and should engage in ethical aspects of AANH. Roles may vary depending on professional discipline and setting, but each interdisciplinary team member provides critical value. We also strongly encourage all readers to engage in conversations surrounding the topic of AANH and ethics: disseminating the principles in the position paper via local, regional, and national conference presentations, journal club discussions, grand rounds, and within the fundamental educational preparation of all clinicians involved in nutrition therapy practice.
