Perspectiva ética en la nutrición y los cuidados paliativos: un enfoque en la atención a los pacientes con demencia avanzada

Albert Barrocas; Denise Baird Schwartz; Sonia Echeverri

doi:10.35454/rncm.v4n2.244

Authors

Albert Barrocas http://orcid.org/0000-0001-8506-7244
Denise Baird Schwartz https://orcid.org/0000-0001-9895-9073
Sonia Echeverri Fundación Santa Fe de Bogotá, Colombia. http://orcid.org/0000-0002-2270-0468

DOI:

https://doi.org/10.35454/rncm.v4n2.244

Keywords:

Palliative care, Patient-centered care, Ethics, Nutritional interventions, Dementia

Abstract

Palliative care (PC) is an aspect of healthcare that is receiving increasing attention. As with other areas of medicine, PC is influenced by what can be done technologically, what should be done ethically, and what must be done legally. I.e., the Troubling Trichotomy. This article deals primarily with the ethical perspectives of PC and nutrition. While two of the authors are from the U.S., a third provides a valuable international perspective. A brief introduction on ethics includes a discussion of the components of principalism, currently the most commonly used ethical approach across the world, including the Cartagena Declaration.

The success of interventions dealing with PC depend on accountability, communication and teamwork. The various roles of the different stakeholders, including the individual/family/surrogate decision-maker, treating healthcare team, PC team, and healthcare facilities, are discussed.

Patient-centered care requires effective communication. In complex cases, a number of specific recommendations by the treating PC team are required to reach this goal. A basic pre-requisite for a successful communication is differentiating PC from hospice care.

We review these concepts in detail for patients with advanced dementia, including the definition, signs, symptoms, nutritional needs, and interventions. Since most individuals with advanced dementia are elderly, it is important to note that aging is a process and not a disease, and that it often mimics the signs and symptoms of malnutrition. The responsibilities of the various PC, nutrition, and ethics stakeholders are outlined, followed by an illustrative case with follow-up questions and actions.

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