LEARNING OUTCOME: To identify attitudes and practices of dietitians related to the ethics of feeding terminally ill patients

The American Dietetic Association's (ADA's) position paper on feeding terminally ill patients, which was published in 1987 and reviewed and updated in 1992, advocates that the dietitian take an active role in developing criteria for feeding the terminally ill adult within the practice setting, participate in making recommendations for each case, and be a part of the hospital ethics committee. According to the position paper, dietitians need to be aware of personal factors that could interfere with the execution of their responsibilities in dealing with the terminally ill. No research was found in the literature indicating whether or not dietitians are actually able to follow the ADA guidelines.

In order to determine how dietitians are using these guidelines, a survey was sent to 105 hospital-based dietitians, who had or have had experience with critically ill patients, to determine their attitudes and practices in relation to ethical issues in feeding the terminally ill; 71 surveys were returned. The surveys indicated the majority of dietitians were not following the guidelines at that time. Less than one-third of the facilities had written guidelines for feeding the terminally ill or for withdrawing nutritional support. The medical climate was not felt to be accepting of the dietitian participating in the making of decisions regarding nutrition support for the terminally ill. A majority of the dietitians (80%) felt that more education and training were needed in the area of ethics and feeding the terminally ill patient.

This survey demonstrates the need for more education and training of dietitians regarding feeding the terminally ill. Dietitians responses and comments indicated a positive interest in this area of patient care.