Enteral Nutrition

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Nutrition & Hydration/Persistent Vegetative State (PVS)

After studying the course materials located on Module 7: Lecture Materials & Resources page, answer the following:

  1. Cure / care: compare and contrast.
  2. Basic care: Nutrition, hydration, shelter, human interaction.
    • Are we morally obliged to this? Why? Example
  3. Swallow test, describe; when is it indicated?
  4. When is medically assisted N/H indicated?
    • Briefly describe Enteral Nutrition (EN), including:
      • NJ tube
      • NG tube
      • PEG
    • Briefly describe Parenteral Nutrition (PN), including:
      • Total parenteral nutrition
      • Partial parenteral nutrition
  1. Bioethical analysis of N/H; state the basic principle and briefly describe the two exceptions.
  2. Case Study: Terry Schiavo (EXCEL FILE on Module 7: Lecture Materials & Resourcespage). Provide a bioethical analysis of her case; should we continue with the PEG or not? Why yes or why not?
  3. Read and summarize ERD paragraphs #:  32, 33, 34, 56, 57, 58.

Enteral Nutrition

  1. Cure vs. Care:
    • Cure: This refers to medical interventions aimed at treating the underlying cause of a medical condition with the goal of restoring a patient’s health or eliminating the condition. In the context of a persistent vegetative state (PVS), a cure may involve attempts to reverse the neurological damage or injury that led to the PVS, such as surgery or medications.
    • Care: In the context of PVS, care focuses on providing the necessary support and assistance to maintain the patient’s quality of life. It includes basic care, comfort, and attention to the patient’s physical and emotional needs. Cure may not be possible in PVS cases, so care becomes a primary consideration.
  2. Basic Care and Moral Obligation: Providing basic care, including nutrition, hydration, shelter, and human interaction, is often considered a moral obligation. This is based on the principles of beneficence and nonmaleficence in medical ethics, which emphasize doing good for the patient and avoiding harm.
    • Nutrition and Hydration: It is generally considered morally obligatory to provide nutrition and hydration to individuals in a PVS. Withholding these essentials can lead to suffering and a decrease in the quality of life.
    • Example: If a patient in a PVS requires a feeding tube for nutrition and hydration, failing to provide it could result in the patient experiencing discomfort, dehydration, and malnutrition, which would be ethically problematic.
  3. Swallow Test: The swallow test assesses a patient’s ability to swallow safely. It is indicated when there are concerns about a patient’s ability to swallow food and liquids without the risk of aspiration (inhaling substances into the lungs). During the test, the patient is given a small amount of liquid or food to swallow while being closely monitored for any signs of choking, coughing, or difficulty in swallowing.
  4. Medically Assisted Nutrition and Hydration:
    • Enteral Nutrition (EN):
      • NJ Tube: Nasojejunal tube, which is passed through the nose and into the jejunum (a part of the small intestine).
      • NG Tube: Nasogastric tube, which is passed through the nose and into the stomach.
      • PEG: Percutaneous endoscopic gastrostomy, a surgical procedure to place a feeding tube directly into the stomach through the abdominal wall.
    • Parenteral Nutrition (PN):
      • Total Parenteral Nutrition (TPN): Provides all nutrients intravenously, bypassing the digestive system.
      • Partial Parenteral Nutrition: Provides some nutrients intravenously while allowing partial use of the digestive system.
  5. Bioethical Analysis of Nutrition and Hydration:
    • Basic Principle: The basic principle is to provide nutrition and hydration to maintain a patient’s comfort and prevent suffering.
    • Exceptions: Two exceptions where withholding or withdrawing nutrition and hydration may be considered are when it is medically futile (providing no benefit to the patient) or when it goes against the patient’s previously expressed wishes (e.g., through advance directives).
  6. Terry Schiavo Case Analysis: The bioethical analysis of Terry Schiavo’s case would involve considering her medical condition, the presence of advance directives, the potential for recovery, and the impact on her quality of life. Decisions regarding PEG placement or withdrawal should be made based on the principles of beneficence, nonmaleficence, autonomy, and the patient’s best interests.
  7. ERD Paragraphs Summary: I can provide summaries of the specific paragraphs you mentioned from the Ethical and Religious Directives for Catholic Health Care Services (ERD) if you provide the text or details from those paragraphs.
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