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The Use of Advance Care Planning to Guide Decisions About Artificial Nutrition and Hydration
Author(s) -
Gillick Muriel R.
Publication year - 2006
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/0115426506021002126
Subject(s) - artificial nutrition , directive , medicine , advance care planning , variety (cybernetics) , inclusion (mineral) , management science , risk analysis (engineering) , nursing , parenteral nutrition , intensive care medicine , palliative care , artificial intelligence , computer science , psychology , economics , social psychology , programming language
Advance care planning is important to ensure that patients, when competent, can influence the kind of medical care they receive if they lose decision‐making capacity. Because decisions by surrogates to forgo nutrition support remain controversial, specific inclusion of artificial nutrition and hydration as a part of advance care planning has taken on growing importance. This article reviews the choices about artificial nutrition and hydration that are possible using conventional advance directives such as the living will, the instructional directive, values histories, and combination directives. It summarizes the legal basis for such documents. It also describes the ways that physicians' orders to limit treatment can help implement decisions about the use of artificial nutrition and hydration. Finally, it stresses the importance of clarifying with patients and families the risks and benefits of nutrition support in a variety of common situations such as advanced dementia and metastatic cancer as an essential prerequisite to meaningful advance care planning.