Position of the American Dietetic Association: Ethical and Legal Issues in Nutrition, Hydration, and Feeding

It is the position of the American Dietetic Association that individuals have the right to request or refuse nutrition and hydration as medical treatment. Registered dietitians (RDs) should work collaboratively to make recommendations on providing, withdrawing, or withholding nutrition and hydration in individual cases and serve as active members of institutional ethics committees. RDs have an active role in determining the nutrition and hydration requirements for individuals throughout the lifespan. When patients choose to forgo any type of nutrition and hydration (natural or artificial) or when patients lack decision-making capacity and others must decide whether or not to provide artificial nutrition and hydration, the RD has an active and responsible professional role in the ethical deliberation around that decision. Across the lifespan, there are multiple instances when providing, withdrawing, or withholding nutrition and hydration creates ethical dilemmas. There is strong clinical, ethical, and legal support both for and against administration of food and water when issues arise regarding what is or is not wanted by the patient and what is or is not warranted by empirical clinical evidence. When a conflict arises, the decision to administer or withhold nutrition and hydration requires ethical deliberation. The RD's understanding of nutrition and hydration within the context of nutritional requirements and cultural, social, psychological, and spiritual needs provides an essential basis for ethical deliberation on issues of nutrition and hydration. The RD, as a member of the health care team, has a responsibility to promote use of advanced directives and to identify the nutritional and hydration needs of each individual patient. The RD promotes the rights of the individual patient and helps the health care team implement appropriate therapy.