Nutrition & Hydration/Persistent Vegetative State (PVS)
After studying the course materials located on Module 7: Lecture Materials & Resources page, answer the following:
Cure / care: compare and contrast.
Basic care: Nutrition, hydration, shelter, human interaction.Are we morally obliged to this? Why? Example
Swallow test, describe; when is it indicated?
When is medically assisted N/H indicated?Briefly describe Enteral Nutrition (EN), including:NJ tube
Briefly describe Parenteral Nutrition (PN), including:a. Total parenteral nutrition
b. Partial parenteral nutrition
Bioethical analysis of N/H; state the basic principle and briefly describe the two exceptions.
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?
Read and summarize ERD paragraphs #: 32, 33, 34, 56, 57, 58.
The paper is to be clear and concise and students will lose points for improper grammar, punctuation, and misspelling.
If references are used, please cite properly according to the current APA style.
Cure refers to the treatment or intervention intended to eliminate or cure an underlying condition or disease. On the other hand, care refers to the provision of basic needs and support to enhance the quality of life, such as nutrition, hydration, shelter, and human interaction. In contrast to cure, care does not necessarily aim to eliminate the underlying condition but to improve the patient’s comfort and well-being.
Basic care, such as providing nutrition, hydration, shelter, and human interaction, is a fundamental ethical obligation, regardless of the patient’s condition. Patients in a persistent vegetative state (PVS) require basic care to maintain their survival, and withdrawing such care is considered morally unacceptable. For example, it is essential to provide artificial hydration and nutrition to patients in a PVS, such as via a feeding tube, as it is their basic right to receive these necessities.
A swallow test is a medical evaluation that determines a patient’s ability to swallow food and drink safely. It is indicated when a patient has difficulty swallowing or is at risk of aspiration, where food or drink enters the lungs instead of the stomach. The test involves administering various food and drink consistencies while the patient’s swallowing ability is observed.
Medically assisted nutrition and hydration (N/H) may be indicated when a patient cannot take food or drink orally or safely. This can occur in patients with a range of medical conditions, including PVS, where oral intake is not possible. There are various types of enteral nutrition (EN), including nasogastric (NG) tubes, nasojejunal (NJ) tubes, and percutaneous endoscopic gastrostomy (PEG) tubes. EN involves the delivery of nutrition directly into the digestive system via a tube.
Total parenteral nutrition (TPN) and partial parenteral nutrition (PPN) are forms of parenteral nutrition (PN). TPN provides all necessary nutrients, such as carbohydrates, proteins, and fats, via a vein, bypassing the digestive system entirely. PPN is a less complex form of PN and provides partial nutrition support, typically via a peripheral vein.
The basic principle for bioethical analysis of N/H is the principle of double effect. This principle states that it is morally acceptable to perform an action that has two effects, one intended and the other unintended, as long as the intended effect is not morally wrong, and the unintended effect is not disproportionate to the intended effect. Two exceptions to this principle are the principle of totality, which argues that it is morally acceptable to sacrifice a part for the sake of the whole, and the principle of autonomy, which emphasizes the importance of an individual’s right to self-determination.
In the case of Terry Schiavo, a bioethical analysis of her situation indicates that continued provision of PEG would not be in her best interest as it would not improve her quality of life. Terry was in a persistent vegetative state, and the provision of PEG would only prolong her life artificially, without any hope of recovery. Additionally, it was evident that Terry would not have wanted to be kept alive artificially, and her right to self-determination should be respected.
ERD Paragraph #32 emphasizes the obligation of healthcare providers to provide basic care, including nutrition and hydration, to patients in a PVS. Paragraphs #33 and #34 address the need for ongoing assessments and the provision of care based on the patient’s individual needs and circumstances. Paragraphs #56, #57, and #58 address the ethical obligation to provide care for patients at the end of life, emphasizing the importance of palliative care and pain management while ensuring that the patient’s dignity and autonomy are respected.