title: ESPEN guideline on ethical aspects of artificial nutrition and hydration.
abstract: The worldwide debate over the use of artificial nutrition and hydration remains controversial although the scientific and medical facts are unequivocal. Artificial nutrition and hydration are a medical intervention, requiring an indication, a therapeutic goal and the will (consent) of the competent patient.
  
  
  
  The guideline was developed by an international multidisciplinary working group based on the main aspects of the Guideline on "Ethical and Legal Aspects of Artificial Nutrition" published 2013 by the German Society for Nutritional Medicine (DGEM) after conducting a review of specific current literature. The text was extended and introduced a broader view in particular on the impact of culture and religion. The results were discussed at the ESPEN Congress in Lisbon 2015 and accepted in an online survey among ESPEN members.
  
  
  
  The ESPEN Guideline on Ethical Aspects of Artificial Nutrition and Hydration is focused on the adult patient and provides a critical summary for physicians and caregivers. Special consideration is given to end of life issues and palliative medicine; to dementia and to specific situations like nursing care or the intensive care unit. The respect for autonomy is an important focus of the guideline as well as the careful wording to be used in the communication with patients and families. The other principles of Bioethics like beneficence, non-maleficence and justice are presented in the context of artificial nutrition and hydration. In this respect the withholding and withdrawing of artificial nutrition and/or hydration is discussed. Due to increasingly multicultural societies and the need for awareness of different values and beliefs an elaborated chapter is dedicated to cultural and religious issues and nutrition. Last but not least topics like voluntary refusal of nutrition and fluids, and forced feeding of competent persons (persons on hunger strike) is included in the guideline.
authors.affiliation: UNESCO Chair on Bioethics at the Medical University of Vienna, Collections and History of Medicine - Josephinum, Medical University of Vienna, Waehringerstrasse 25, A-1090 Vienna, Austria. Electronic address: christiane.druml@meduniwien.ac.at.
authors.forename: Christiane
authors.initials: C
authors.lastname: Druml
authors.affiliation: Department of Medicine, Kantonsspital Winterthur, Brauerstrasse 15, Postfach 834, 8401 Winterthur, Switzerland. Electronic address: peter.ballmer@ksw.ch.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Ballmer
authors.affiliation: Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: wilfred.druml@meduniwien.ac.at.
authors.forename: Wilfred
authors.initials: W
authors.lastname: Druml
authors.affiliation: Department of Early Rehabilitation, Klinik Bavaria Kreischa, An der Wolfsschlucht 1-2, 01731 Kreischa, Germany. Electronic address: frank.oehmichen@klinik-bavaria.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Oehmichen
authors.affiliation: Department of Clinical Chemistry, University of Liverpool, Duncan Building, Daulby Street, Liverpool L69 3GA, UK. Electronic address: shenkin@liverpool.ac.uk.
authors.forename: Alan
authors.initials: A
authors.lastname: Shenkin
authors.affiliation: Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Jean Leven Building, 6th Floor, Tel Aviv, Israel. Electronic address: psinger@clalit.org.il.
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
authors.affiliation: Department of Surgery, Academic Hospital Maastricht, Peter Debeyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: pb.soeters@ah-unimaas.nl.
authors.forename: Peter
authors.initials: P
authors.lastname: Soeters
authors.affiliation: Department of General Surgery and Surgical Intensive Care, St Georg Hospital, Delitzscher Straße 141, 04129 Leipzig, Germany. Electronic address: Arved.Weimann@sanktgeorg.de.
authors.forename: Arved
authors.initials: A
authors.lastname: Weimann
authors.affiliation: Department of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70599 Stuttgart, Germany. Electronic address: bischoff.stephan@uni-hohenheim.de.
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Bischoff
mesh_terms: D000328:Adult; D065246:Culturally Competent Care / Q000941:ethics / Q000331:legislation & jurisprudence / Q000592:standards*; D004046:Dietetics; D005060:Europe; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000009:adverse effects / Q000941:ethics / Q000451:nursing / Q000592:standards*; D006801:Humans; D007883:Legislation, Medical; D018529:Nutritional Support / Q000009:adverse effects / Q000941:ethics / Q000451:nursing / Q000592:standards*; D010166:Palliative Care / Q000941:ethics / Q000331:legislation & jurisprudence / Q000592:standards; D010342:Patient Acceptance of Health Care; D026684:Personal Autonomy; D057285:Precision Medicine; D011368:Professional-Family Relations / Q000941:ethics; D011369:Professional-Patient Relations / Q000941:ethics; D011788:Quality of Life; D012958:Societies, Scientific; D013727:Terminal Care / Q000941:ethics / Q000331:legislation & jurisprudence / Q000592:standards; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence / Q000592:standards
keywords: Artificial nutrition; Culture and religion; Enteral nutrition; Ethics and law; Hydration; Parenteral nutrition