LIFE-SUSTAINING NUTRITION SUPPORT FOR THE TERMINALLY-ILL ELDERLY - DIETITIANS ETHICAL ATTITUDES AND BELIEFS

Advances in medical technology have resulted in the increased ability of the medical profession to treat and extend the lives of many patien ts. Along with these life-sustaining technologies tomes a greater requ irement for healthcare professionals to be able to deal with the ethic al issues and dilemmas that may arise. The same technologies that supp ort life may also prolong dying. As part of an interdisciplinary medic al team, dietitians must develop the analytical skills required to man age ethical dilemmas. The purpose of this study was to determine how, the ethical beliefs of professional dietitians influence their clinica l tore judgements as they relate to the withholding and withdrawal of nutriture from terminally ill elderly patients. A questionnaire was mo iled to a sample of members of The Canadian Dietetic Association (n = 2408); 1724 responded with completed questionnaires, far a response ra te of 72%. Six frameworks which may affect a dietitian's decision to r ecommend that nourishment he continued or discontinued were identified : attitude towards removal of life support; religious background; atti tude towards euthanasia; acceptance of professional authority; ethics experience, and belief in individual autonomy. Dietitians view these i ssues as ones that must be seriously considered and they view patients and families as being most important in the decision making process. To deal effectively with the changing dynamics of the healthcare syste m, dietitians will need to understand moral responsibility and become skilled in assisting with decisions about complex ethical issues. The information generated by this study will provide a foundation for the development of educational criteria to address ethical issues for diet etic students, as well as continuing education for practicing dietitia ns.