Ethical issues in the nutritional support of the terminal patient

Nutritional support is well accepted medically, morally, and legally and should be provided to all patients with hope of recovery. In the responsive terminal patient, nutritional support should be continued if the patient desires it and might benefit from it indirectly. Oral feeding is the easiest and safest method. Enteral feeding may present some risks, and hyperalimentation may not commonly be indicated because of the risks, costs, and restrictions placed upon the patient. The patient's wishes, when known, should have the highest priority, and benefits should always outweigh the risks. In the unresponsive terminal patient, there would appear to be no advantage in continuing nutritional support, since no benefit can occur. The dietitian can play an essential role in planning nutritional support with the health team for the still responsive patient and help the family make the best medical and moral decision when the patient is unresponsive and death approaches.