TY - JOUR
T1 - Ethical considerations of medical nutritional therapy at end of life
T2 - the Israel perspective
AU - Hellerman Itzhaki, Moran
AU - Noy, Ofir Har
AU - Kagan, Ilya
AU - Papier, Irena
AU - Cherlow, Yuval
AU - Zaharoni, Hila
AU - Yanai, Shirly
AU - Orion, Yael
AU - Sprung, Charles L.
AU - Singer, Pierre
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2023/8
Y1 - 2023/8
N2 - 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.
AB - 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.
KW - Cancer
KW - End of life
KW - Enteral nutrition
KW - Palliative care
KW - Parenteral nutrition
KW - Terminal dementia
UR - http://www.scopus.com/inward/record.url?scp=85164729755&partnerID=8YFLogxK
U2 - 10.1016/j.nutos.2023.06.001
DO - 10.1016/j.nutos.2023.06.001
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AN - SCOPUS:85164729755
SN - 2667-2685
VL - 50
SP - 16
EP - 26
JO - Clinical Nutrition Open Science
JF - Clinical Nutrition Open Science
ER -