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The Ethics of Nutrition Support-Ripped from the Headlines.

We all remember March 2005 when our discipline was thrust into the national spotlight with the public controversy surrounding the Terri Schiavo case. The ethical issues surrounding removal of her feeding tube were debated endlessly in our news media and led many laypersons to seek religious guidance, cling to the symbolic meaning of food, and fear—rather than embrace—advance directives regarding end-of-life decisions. The United States Congress was even engaged by passing a controversial relief bill that came to be called the “Palm Sunday Compromise.” So compelling were these issues surrounding the medical therapy in which we specialize that months after the final ruling and Terri’s death, these important issues still circulated in popular culture through paralleling episodes on the television shows Arrested Development, Eli Stone, and Law and Order: Special Victim’s Unit. Even South Park won an Emmy Award for Outstanding Animated Program for an episode entitled ‘Best Friends Forever’, featuring a character similar to Schiavo. While this issue was ‘ripped from the headlines’ for everyday Americans, as experts in nutrition support we must also serve as experts regarding the complexities associated with these life-sustaining therapies and as authorities concerning its appropriate use. As such, in September 2008 the A.S.P.E.N. Board of Directiors approved the statement below regarding the ethics of withholding and/or withdrawing nutrition support therapy. In addition, I am pleased to have recently formed the A.S.P.E.N. Nutrition Support Ethics Task Force, to be chaired by Dr. Albert Barrocas, with the charge of thoroughly contemplating these important issues and developing a standalone position paper on nutrition support ethics to be reviewed and approved by the A.S.P.E.N. Board of Directors. Few are the cases, such as that of Terri Schiavo, that attract the national spotlight, but each is complex and immensely personal. The leadership and perspective we can bring to the issue is critically important and worthy of our attention. As you contemplate this issue, I’d love to hear what’s on your mind––please send your comments, suggestions, concerns, and thoughts to me at ncp@aspen.nutr.org.