Nutrition & Hydration/Persistent Vegetative State (PVS)

(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 NG tube PEG 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 & Resources page). 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.
Submission Instructions: 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. (Nutrition & Hydration/Persistent Vegetative State (PVS))

Nutrition & Hydration/Persistent Vegetative State (PVS)

Cure vs. Care: A Comparison

Cure and care are fundamental concepts in healthcare. Cure aims to eliminate disease and restore health. It involves medical interventions, treatments, and medications. For instance, antibiotics cure bacterial infections by eradicating bacteria. Care, however, focuses on comfort, well-being, and quality of life. It includes basic needs like nutrition, hydration, and emotional support. An example of care is providing palliative care to a terminally ill patient to ease pain and discomfort.

Basic Care: Moral Obligations

Basic care encompasses nutrition, hydration, shelter, and human interaction. Society holds a moral obligation to provide these essentials. Neglecting these needs can result in severe consequences, including death. For instance, a swallow test evaluates a patient’s ability to safely swallow food and liquids. It is indicated when there are signs of dysphagia, such as coughing while eating. Medically assisted nutrition and hydration are indicated when patients cannot meet their needs orally, such as in cases of severe dysphagia. (Nutrition & Hydration/Persistent Vegetative State (PVS))

Enteral Nutrition (EN)

Enteral Nutrition (EN) involves delivering nutrients directly into the gastrointestinal tract. This method is preferred when the digestive system functions properly but the patient cannot ingest food orally.

NJ Tube: A nasojejunal tube is inserted through the nose into the jejunum. It is used when gastric feeding is not tolerated.
NG Tube: A nasogastric tube is inserted through the nose into the stomach. It is used for short-term feeding.
PEG: A percutaneous endoscopic gastrostomy tube is placed directly into the stomach through the abdominal wall. It is used for long-term feeding.

Parenteral Nutrition (PN)

Parenteral Nutrition (PN) delivers nutrients directly into the bloodstream. It is used when the digestive system cannot be used.

Total Parenteral Nutrition (TPN): Provides all nutritional needs intravenously. It is used for patients with non-functioning gastrointestinal tracts.
Partial Parenteral Nutrition (PPN): Supplements oral intake or enteral nutrition. It provides partial nutritional support.

Bioethical Analysis of Nutrition and Hydration

The basic principle is to provide care that respects patient autonomy and beneficence. However, there are exceptions:

When treatment is futile or does not benefit the patient.
When treatment imposes a disproportionate burden relative to its benefits.

Case Study: Terry Schiavo

The Terry Schiavo case raises significant bioethical questions. Schiavo was in a persistent vegetative state, and her family was divided over continuing her PEG feeding. Ethical analysis should consider patient autonomy, quality of life, and medical futility.

Continuing PEG feeding in this case might not improve her quality of life or lead to recovery. Discontinuing it respects her previously expressed wishes and recognizes the burden of prolonged artificial nutrition.

Summary of ERD Paragraphs

ERD 32: Emphasizes the dignity of every human person and the obligation to provide basic care.
ERD 33: Stresses the need for competent decision-making in healthcare.
ERD 34: Highlights the importance of respecting patient autonomy and informed consent.
ERD 56: Discusses the moral obligation to provide food and water, even by artificial means, unless it is futile or burdensome.
ERD 57: Encourages the use of palliative care and comfort measures.
ERD 58: Clarifies the conditions under which artificial nutrition and hydration can be withheld or withdrawn.

In Terry Schiavo’s case, the analysis suggests discontinuing PEG feeding aligns with her wishes and the principle of not imposing disproportionate burdens. It respects her dignity and the quality of life considerations outlined in the ERD.

References

Florida Nurses Association. Barbara Lumpkin Institute. (n.d.). Retrieved from https://www.floridanurse.org/

Nutrition & Hydration/Persistent Vegetative State (PVS)