The question is whether or not a particular treatment or intervention will restore or enhance the quality of life for a particular patient
☛ if the answer is yes, and it can be justified on the best clinical grounds, then it is ethically right to do it
☛ if not, it should not be done
☛ in developing countries, cost may be a major additional consideration
☛ ‘You have to do something!’ is never a justification for artificial nutrition
Weight loss and wasting in advanced cancer
☛ is nearly always due to the cachexia syndrome
☛ is caused by changes to metabolism secondary to the cancer
☛ is never responsive to enteral or parenteral nutrition
↳ i.e. they are futile
↳ parenteral nutrition is also associated with
* central venous catheterization
* infections
* expense
↳ enteral nutrition is also associated with
* abdominal cramps
* diarrhoea
* feeding tubes
☛ is occasionally due to malnutrition and starvation
↳ patients with upper gastrointestinal obstruction, not terminally ill from their cancer warrant feeding by a nasogastric tube or gastrostomy
↳ patients receiving therapy that will prevent them eating for 2 weeks or more warrant consideration for parenteral feeding
↳ for patients with persistent or recurrent bowel obstruction, whether parenteral nutrition is warranted depends on individual clinical circumstances
Source:
The IAHPC Manual of Palliative Care 3rd Edition
https://web.archive.org/web/20210122105526/https://hospicecare.com/uploads/2013/9/The%20IAHPC%20Manual%20of%20Palliative%20Care%203e.pdf
