title: Ethical considerations of refusing nutrition after stroke.
abstract: The aim of this article is to analyse and discuss the ethically problematic conflict raised by patients with stroke who refuse nutritional treatment. In analysing this conflict, the focus is on four different aspects: (1) Is nutritional treatment biologically necessary? (2) If necessary, is the reason for refusal a functional disability, lack of appetite or motivation, misunderstanding of the situation or a genuine conflict of values? (3) If the latter, what values are involved in the conflict? (4) How should we deal with the different kinds of refusal of nutritional treatment? We argue that patients' autonomy should be respected as far as possible, while also considering that those who have suffered a stroke might re-evaluate their life as a result of a beneficial prognosis. However, if patients persist with their refusal, health care professionals should force nutritional treatment only when it is clear that the patients will re-evaluate their future life.
authors.affiliation: School of Health Sciences, University College of Borås, Borås, Sweden. lars.sandman@hb.se
authors.forename: Lars
authors.initials: L
authors.lastname: Sandman
authors.forename: Ingrid
authors.initials: I
authors.lastname: Agren Bolmsjö
authors.forename: Albert
authors.initials: A
authors.lastname: Westergren
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D001066:Appetite / Q000502:physiology; D003220:Conflict, Psychological; D003680:Deglutition Disorders / Q000209:etiology / Q000523:psychology* / Q000628:therapy*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000523:psychology; D008297:Male; D016743:Mental Competency / Q000523:psychology; D008875:Middle Aged; D009042:Motivation; D018529:Nutritional Support / Q000941:ethics / Q000523:psychology; D010353:Patient Education as Topic; D026684:Personal Autonomy; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology; D012945:Social Values; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D016312:Treatment Refusal / Q000941:ethics / Q000523:psychology; D026712:Value of Life