1. END OF LIFE ARTIFICIAL NUTRITION AND HYDRATION Emily Vale

2. End of life vs. Palliative Care  End of life  Final days and hours of life 1  Palliative care  Improving quality of life  Associated with life-threatening illness 1

3. Patient-Centered Care 1  New trend in health systems  Quality of life  Removed focus from illness/disease  Focus on health

4. Artificial Nutrition and Hydration 2  Medical treatment  Receiving nutrition and hydration through an IV or PEG tube  Patient not able to take by mouth

5. End of Life Care Views 3  Newer views on end of life care  Current views challenged  Multiple positions  Ethical  Legal  Medical  Hospice  Religious

6. Ethical 3  Principalism  Autonomy  Beneficence  Nonmaleficence  Justice  Deontology  Utilitarianism

7. Medical 3  Uses prinicipalism  Core principals:  Autonomy  Beneficence  Nonmaleficence  Justice

8. Hospice 2  Artificial nutrition and hydration (ANH) is different than eating or drinking  ANH does not cure the individual  ANH refusal is not suicide

9. Religious 3  Many different religions and views  Examples:  Roman Catholicism  Judaism - three divisions  Presbyterian Church

10. Legal  Advance directives  Living wills  Powers of attorney  Surrogate  Judicial system  Legislative system

11. Does Age Matter?  Advanced age patients have decreased health care spending 4  Doctor statement  Easier in older patients compared to younger 5

12. Hunger or Thirst?  Van der Riet et al. (2006) conducted research  Interviews of terminally ill inpatients and family  No complaints of hunger or thirst

13. Easier Said Than Done  Discord amongst medical professionals  Discord amongst families  Terri Schaivo case

14. Resources  1. Fleming M, Hollins Martin CJ, Martin CR: Nutritional intervention and quality of life in palliative care patients. British Journal of Nursing November 2011; 20(20): 1320- 1324. Available from Academic Search Complete, Health Sources: Nursing/Academic Edition  2. National Hospice and Palliative Care Organization. (2009). Artificial nutrition (food) and hydration (fluids) at the end of life. Retrieved from http://www.caringinfo.org/files/public/brochures/Artificial NutritionAndHydration.pdf  3. Andrews MR, Geppert, CMA (2007). The A.S.P.E.N. Nutrition Support Core Curriculum. United States: American Society for Parenteral and Enteral Nutrition.

15. Resources  4. Somogyi-Zalud E, Zhong Z, Hamel MB, Lynn J: The use of life-sustaining treatments in hospitalized persons aged 80 and older. Journal of the American Geriatrics Society May 2002; 50(5): 930-934. Available from Academic Search Complete.  5. Van der Riet P, Higgins I, Good P, Sneesby L: A discourse of difficult clinical situations in relation to nutrition and hydration during end of life care. Journal of Clinical Nursing July 2009; 18(14): 2104-2111. Available from CINAHL Plus with Full Text.