Health care team members, including the dietitian, must set patient-centered treatment goals that are handled individually and that respect the unique values and personal decision of the patient. The patient's expressed desire is the primary guide for determining the extent of nutrition and hydration once the patient is diagnosed as being in a PVS. Within the extent of the law, the family should share decision making when the patient's preference is not stated and the family is in agreement about medical care. The health care team will need to discuss with the family as needed the issues of ethics, values, religious guidelines, and pastoral advice. If the patient's choice is feeding, the dietitian will ensure that the composition of the feeding promotes nutritional health. If the patient's choice is cessation of feeding, the dietitian should explain what is known about the duration of time between cessation of feeding and death. Sensitivity to the family's needs and responsiveness to their questions are imperative in both scenarios. Within institutions, the ethics committee should help establish and implement defined written guidelines for care of the permanently unconscious. The dietitian should be required to be a member of or consultant to such a committee and should serve an integral role in development of institutional policy. The dietitian must provide education about nutrition and hydration issues, serve as a patient advocate, and participate in the legal and ethical issues regarding feeding. The dietetics community is involved in the legislative arena at the state and local level to promote the use of advanced directives and to affect legislative and societal changes that result in appropriate care for patients in a PVS. ■ ADA Position adopted by the House of Delegates on October 16, 1994. This position is in effect until 1999. The American Dietetic Association authorizes republication of the position paper, in its entirety, provided full and proper credit is given. Requests to use portions of the position must be directed to ADA Headquarters at 800/977-1600, ext 4896. ■ Recognition is given to the following for their contributions:. Author:. Julie O'Sullivan Maillet, PhD, RD. Reviewers:. Madalon Amento, DrPH, RN; Consulting Dietitians in Health Care Facilities dietetic practice group (Carlene Russell, MS, RD): Claire Dalidowitz, MS, RD; Dietititans in Nutrition Support dietetic practice group (Nancy Wellman, PhD, RD); Linda Mittleman, JD, MS, RD.
All Science Journal Classification (ASJC) codes
- Food Science
- Nutrition and Dietetics