Ethical considerations of medical nutritional therapy at end of life: the Israel perspective

The major ethical dilemma regarding feeding a person at the end of their life in Israel is related to the medical team's ability to not provide food. In addition to the medical indications, the decision-making process needs to include ethnic considerations, religious positions and a strong collective memory related to the Holocaust and post-Holocaust behavior. An Expert group of professionals regularly faced with these dilemmas gathered to address this issue. The group included Nutrition Specialists, Neurologists, Geriatricians, Oncologists and Specialists in palliative care, Nurses, Dieticians, Speech therapists but also Lawyers and Religion experts. The conclusions suggested: 1) One should evaluate the patient's ability to eat safely and sufficiently, assessed by speech therapist and dietician evaluations. 2) If not successful, a discussion between the team, the patient, if available, and the family is initiated. 3) If oral nutrition is possible it is encouraged. 4) If not, artificial nutrition should be discussed. 5) The family's will to never stop providing food and water according to Jewish law has to be acknowledged when the medical team does not suggest nutritional therapy. Emotional aspects, religious beliefs and nutritional indications have to be reconciled and a consensus should be reached.