Feeding the terminally ill: dietitians' attitudes and beliefs

Medical, legal, and bioethical discussions have focused on withholding or withdrawing nourishment from adults who are terminally ill or in persistent vegetative states, yet few discussions have considered the dietitian's role. In June 1990, the Supreme Court upheld an individual's right to refuse life-prolonging procedures, provided those wishes had been clearly documented. This decision, and The American Dietetic Association's 1987 guidelines for feeding the terminally ill, may enable dietitians to evaluate complicated situations regarding feeding and nonfeeding of patients. A survey sent to 590 registered dietitians in The American Dietetic Association's Nutrition Support dietetic practice group resulted in a 42% (n = 250) response rate. In general, dietitians were more willing to discontinue total parenteral nutrition than to discontinue enteral, noninvasive enteral, or oral feedings. They thought that feeding could be discontinued if it causes pain or worsens the condition, if death is imminent, or if the patient has requested that feeding be stopped. University courses and continuing education programs on the ethics and legalities of feeding terminally or critically ill adults will enable dietitians to take active roles in the decision-making process and to promote awareness of relevant issues with patients and families.