The National Catholic Bioethics Center (NCBC) is calling on nurses to respond to the American Nurses Association Draft Position Statement on Forgoing Nutrition and Hydration. Responses should be emailed to the ANA by April 28. The National Catholic Bioethics Center has grave concerns with the draft position. The NCBC's reservations with the American Nursing Association fall into three broad categories.
First, the ANA position marginalizes the expertise of health care personnel by asserting "the acceptance or refusal of food and fluids, whether delivered by normal or artificial means must be respected." Dr. Marie Hilliar, NCBC Director of Bioethics and Public Policy counters this assertion with:
Again, while consent is sacrosanct, it is not exclusive. The position erroneously states that adults with capacity, or in the event of incapacity their surrogates, are in the best position to evaluate the harms and benefits of nutrition and hydration. This statement does not account for the fact that the health care professionals always have been in the best position to judge the potential benefits, risks, side effects, and prognostic indicators of a particular treatment modality. The place for patient/surrogate wishes in health care decision?making is whether those benefits?burdens are worthwhile –i.e., whether those benefits?burdens are consistent with the patient’s goals of care…If the request (for the denial of care) is based on an inability to assimilate the nutrition and hydration, or a contraindication for either oral or assisted nutrition or hydration, e.g., major systems are shutting down, then withholding them is consistent with non?maleficence. However, if depression or pain is driving such a request, there must be an attempt to treat such pathology.
Secondly, the document advocates for the adherence to advance directives even when they run counter to the patient's well being. Dr. Hilliard again offers the NCBC response:
Again, the registered nurse is not a contracted provider of whatever services are requested by a customer. Clearly, if an advanced directive required that assisted nutrition and hydration always be provided, despite that fact that the patient is in terminal congestive heart failure, and such hydration would be contraindicated, there is an obligation to do no harm. The same would be true is assisted nutrition causes aspiration pneumonia. The document needs to provide for a mechanism of external review, as well as for the legally and ethically recognized conscience rights of the registered nurse to transfer care.
Finally, the document regards the surrogate decision as one who makes medical choices without regard to the expressed will of the patient. If the expressed will of the patient is known, it must be considered.
Dr. Hilliard summarizes the concerns as follows:
In summary, this draft document negates the professional role of a registered nurse as a nurse advocate, providing beneficent and non?maleficent care. It treats the registered nurse as a contracted provider of requested services of a customer, regardless of the implications for the withholding or withdrawing of such basic care. Choosing to value one principle (autonomy) over many others (and these others are reasonable) is inconsistent with a public policy statement. Bioethicists, medical professionals, and the educated public have not come close to reaching consensus on a hierarchy of moral principles. In the absence of reflective consensus, a policy statement should give guidance consistent with numerous reasonable moral perspectives. The present ANA statement rather, endorses a minority position according to which the principle of autonomy assumes principal authority. To the extent that the ANA statement reflects a very narrow and exclusive view of the importance of the patient’s wishes, it fails to function as an ethically authoritative position.
Dr. Hilliard is a nurse, a former chair of a state Nurses' Association Ethics Committee and a former executive officer of a state board of nursing. She will be speaking at Our Lady of Hope Cathoic Church in Potomac Falls on Thursday, April 29, 2010 at 8:00 p.m. Her presentation is entitled Rationing Care: Violating Those with Disabilities and those at Life's End. For more information on this presentation call 703-669-4457.
For More Info:
Full text of ANA position statement on denial of nutrition and hydration
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