ESPEN practical guideline on ethical aspects of medical nutrition therapy

The provision of medical nutrition therapy (MNT) is a medical intervention that requires an indication, a therapeutic goal, and the consent of the patient. The decision-making process surrounding MNT often involves complex ethical considerations. The aim of this guideline is to provide practical recommendations on an ethical approach to the decision-making process in clinical nutrition. This practical guideline was developed by an international multidisciplinary working group. The practical, solely consensus-based guideline is based on and updates the 2016 ESPEN Guideline on Ethical Aspects of Artificial Nutrition and Hydration, which has been shortened, supplemented with flowcharts, and expanded to include 3 additional ethical statements in palliative care and 1 new statement concerning human rights in clinical nutrition. Two Delphi rounds and a consensus conference were held to reach consensus. The guideline offers a critical summary for clinicians and caregivers regarding the ethics of MNT in special situations, describes common ethical dilemmas, and proposes an algorithm for the decision-making process. The provision of MNT must be undertaken in the patient's best interests, for their benefit, improvement, or cure. MNT should not expose the patient to disproportionate or unjustifiable risks, and must be indicated in line with current scientific data and guideline recommendations. If the benefit seems clear to the health care professional, the MNT must nevertheless be approved by the patient, who must be adequately informed of the aim and consequences. This guideline places particular emphasis on end-of-life issues, palliative medicine, dementia, and specific scenarios such as nursing care and intensive care. In a multicultural and pluralistic society faced with decisions to feed sick patients in special conditions, it is imperative that the reasoning and the course of action in clinical nutrition are presented in accordance with good clinical practice, adhering to ethical principles.