{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:13:24Z","timestamp":1753888404491,"version":"3.41.2"},"reference-count":54,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Bio\u00e9t."],"abstract":"<jats:p>Abstract Given the lack of scientific evidence, decisions regarding the administration of artificial nutrition and hydration in terminally ill patients constitute an important ethical dilemma due to the conflict between \u201ctreat\u201d and \u201ccare\u201d perspectives and the varying usage depending on the legal and cultural background across countries. This study aims to explain whether this practice configures a basic care intervention or a futile medical treatment. Therefore, we review the national guidelines and codes of ethics from several European countries. Countries such as Portugal, Italy, and Poland view it as a basic care intervention, whereas France, England, Norway, Ireland, Germany, Finland, Netherlands, Belgium, and Switzerland, as a medical treatment. Moreover, countries such as Romania, Croatia, and Hungary lack such legal framework. The different approaches regarding the care of terminally ill patients can reflect differences on cultural perspectives.<\/jats:p>","DOI":"10.1590\/1983-803420243604en","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T12:34:03Z","timestamp":1718368443000},"source":"Crossref","is-referenced-by-count":0,"title":["Ethics, artificial nutrition, and hydration in terminal patients"],"prefix":"10.1590","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4440-6530","authenticated-orcid":false,"given":"Miguel \u00c2ngelo Basto Clemente de Oliveira e","family":"Magalh\u00e3es","sequence":"first","affiliation":[{"name":"Universidade do Porto,  Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4364-5535","authenticated-orcid":false,"given":"Maria Paula Correia Ribeiro da Costa e","family":"Silva","sequence":"additional","affiliation":[{"name":"Instituto Portugu\u00eas de Oncologia,  Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5160-7043","authenticated-orcid":false,"given":"Ivone Maria Resende Figueiredo","family":"Duarte","sequence":"additional","affiliation":[{"name":"Universidade do Porto,  Portugal"}]}],"member":"530","published-online":{"date-parts":[[2024]]},"reference":[{"issue":"1","key":"ref1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/0148607109347209","article-title":"Ethical issues in artificial nutrition and hydration: a review","volume":"34","author":"Geppert CMA","year":"2010","journal-title":"J Parenter Enteral Nutr"},{"issue":"9","key":"ref2","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1002\/pon.2099","article-title":"Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff","volume":"21","author":"Del R\u00edo MI","year":"2012","journal-title":"Psychooncology"},{"issue":"1","key":"ref3","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1200\/JCO.2004.02.056","article-title":"Doctor, does this mean I'm going to starve to death?","volume":"22","author":"Whitworth MK","year":"2004","journal-title":"J Clin Oncol"},{"issue":"2","key":"ref4","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.bpg.2014.02.005","article-title":"Artificial nutrition at the end of life: ethical issues","volume":"28","author":"Van de Vathorst S","year":"2014","journal-title":"Best Pract Res Clin Gastroenterol"},{"issue":"6","key":"ref5","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1089\/10966210260499104","article-title":"Tube feed or not tube feed?","volume":"5","author":"Hallenbeck J","year":"2002","journal-title":"J Palliat Med"},{"issue":"3","key":"ref6","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/SPC.0b013e328356ab4a","article-title":"Is there a role for parenteral nutrition or hydration at the end of life?","volume":"6","author":"Dev R","year":"2012","journal-title":"Curr Opin Support Palliat Care"},{"issue":"4","key":"ref7","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/SPC.0000000000000171","article-title":"The last days of life: symptom burden and impact on nutrition and hydration in cancer patients","volume":"9","author":"Hui D","year":"2015","journal-title":"Curr Opin Support Palliat Care"},{"issue":"4","key":"ref8","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1080\/01639366.2010.521020","article-title":"Artificial nutrition and hydration at the end of life","volume":"29","author":"Heuberger RA","year":"2010","journal-title":"J Nutr Elder"},{"issue":"3","key":"ref9","first-page":"163","article-title":"Guidelines on artificial nutrition versus hydration in terminal cancer patients","volume":"12","author":"Bozzetti F","year":"1996","journal-title":"European Association for Palliative Care. Nutrition"},{"issue":"2","key":"ref10","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1002\/ncp.10633","article-title":"Ethical aspects of artificially administered nutrition and hydration: an ASPEN position paper","volume":"36","author":"Schwartz DB","year":"2021","journal-title":"Nutr Clin Pract"},{"issue":"1","key":"ref11","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1159\/000509119","article-title":"Principles of clinical ethics and their application to practice","volume":"30","author":"Varkey B","year":"2021","journal-title":"Med Princ Pract"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"36","DOI":"10.21011\/apn.2017.1507","article-title":"Nutrition and hydration in the end-of-life care: ethical issues","volume":"15","author":"Pinho-Reis C","year":"2018","journal-title":"Acta Port Nutr"},{"issue":"5","key":"ref13","doi-asserted-by":"crossref","first-page":"216","DOI":"10.12968\/ijpn.2019.25.5.216","article-title":"Enhancing the decision-making process when considering artificial nutrition in advanced dementia care","volume":"25","author":"De D","year":"2019","journal-title":"Int J Palliat Nurs"},{"issue":"1","key":"ref14","first-page":"80","article-title":"Alimenta\u00e7\u00e3o na dem\u00eancia avan\u00e7ada: documento de consenso da Sociedade Portuguesa de Medicina Interna e da Associa\u00e7\u00e3o Portuguesa de Nutri\u00e7\u00e3o Ent\u00e9rica e Parent\u00e9rica","volume":"27","author":"Pessoa A","year":"2020","journal-title":"Med Interna"},{"issue":"4","key":"ref15","article-title":"Medically assisted hydration for adult palliative care patients","author":"Good P","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"ref16","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/S0899-9007(96)91120-X","article-title":"Guidelines on artificial nutrition versus hydration in terminal cancer patients","volume":"12","author":"Bozzetti F","year":"1996","journal-title":"Nutrition"},{"issue":"5","key":"ref17","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/0885-3924(94)90187-2","article-title":"The use of hypodermoclysis for rehydration in terminally ill cancer patients","volume":"9","author":"Fainsinger RL","year":"1994","journal-title":"J Pain Symptom Manage"},{"issue":"8","key":"ref18","doi-asserted-by":"crossref","first-page":"370","DOI":"10.12968\/ijpn.2000.6.8.9060","article-title":"Hypodermoclysis for control of dehydration in terminal-stage cancer","volume":"6","author":"Cerchietti L","year":"2000","journal-title":"Int J Palliat Nurs"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.clnesp.2020.12.010","article-title":"Ethical issues and dilemmas in artificial nutrition and hydration","volume":"41","author":"Cardenas D","year":"2021","journal-title":"Clin Nutr ESPEN"},{"key":"ref20","first-page":"9","article-title":"Nonconsensual withdrawal of nutrition and hydration in prolonged disorders of consciousness: Authoritarianism and trustworthiness in medicine","volume":"7","author":"Rady MY","year":"2014","journal-title":"Philos Ethics Humanit Med"},{"issue":"6","key":"ref21","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.jand.2013.03.020","article-title":"Position of the academy of nutrition and dietetics: ethical and legal issues in feeding and hydration","volume":"113","author":"Maillet JO","year":"2013","journal-title":"J Acad Nutr Diet"},{"year":"2016","series-title":"Procuradoria-Geral Distrital de Lisboa. Regulamento n\u00ba 707\/2016, de 21 de julho. Regulamento de Deontologia M\u00e9dica","key":"ref22"},{"issue":"3","key":"ref23","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.clnu.2016.02.006","article-title":"ESPEN guideline on ethical aspects of artificial nutrition and hydration","volume":"35","author":"Druml C","year":"2016","journal-title":"Clin Nutr"},{"issue":"24","key":"ref24","doi-asserted-by":"crossref","first-page":"2607","DOI":"10.1056\/NEJMsb052907","article-title":"Appropriate use of artificial nutrition and hydration-fundamental principles and recommendations","volume":"353","author":"Casarett D","year":"2005","journal-title":"N Engl J Med"},{"year":"2011","series-title":"C\u00f3digo de deontolog\u00eda m\u00e9dica: gu\u00eda de \u00e9tica m\u00e9dica","key":"ref25"},{"issue":"12","key":"ref26","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.1007\/s00134-008-1257-7","article-title":"End-of-life care in Spain: legal framework","volume":"34","author":"Cabr\u00e9 L","year":"2008","journal-title":"Intensive Care Med"},{"issue":"1","key":"ref27","doi-asserted-by":"crossref","DOI":"10.1186\/cc7148","article-title":"Ethics review: end of life legislation - the French model","volume":"13","author":"Baumann A","year":"2009","journal-title":"Crit Care"},{"issue":"7","key":"ref28","first-page":"525","article-title":"The project of a law concerning patients' rights at the end of life","volume":"34","author":"Lemaire F","year":"2005","journal-title":"Presse Med"},{"year":"2018","series-title":"British Medical Association. Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent: guidance for decision-making in England and Wales","key":"ref29"},{"year":"2022","series-title":"Treatment and care towards the end of life: good practice in decision making","key":"ref30"},{"issue":"3","key":"ref31","doi-asserted-by":"crossref","first-page":"254","DOI":"10.7861\/clinmedicine.16-3-254","article-title":"Care of dying adults in the last days of life","volume":"16","author":"Hodgkinson S","year":"2016","journal-title":"Clin Med"},{"issue":"1","key":"ref32","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1136\/medethics-2015-102777","article-title":"Court applications for withdrawal of artificial nutrition and hydration from patients in a permanent vegetative state: family experiences","volume":"42","author":"Kitzinger C","year":"2016","journal-title":"J Med Ethics"},{"year":"2013","series-title":"Decision-making processes in the limitation of life-prolonging treatment","key":"ref33"},{"first-page":"33","year":"2019","series-title":"Guide to professional conduct and ethics for registered medical practitioners (Amended)","key":"ref34"},{"year":"2016","series-title":"Palliative Care for the Person with Dementia: Guidance Document 4: Management of Hydration and Nutrition","author":"Hartigan I","key":"ref35"},{"year":"2021","series-title":"Professional Code for Physicians in Germany","key":"ref36"},{"issue":"3","key":"ref37","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.jcrc.2009.06.012","article-title":"Limiting life-sustaining treatment in German intensive care units: a multiprofessional survey","volume":"25","author":"Jox RJ","year":"2010","journal-title":"J Crit Care"},{"year":"2014","series-title":"German Cancer Society, German Cancer Aid, AWMF. German Guideline Programme in Oncology: Palliative care for patients with incurable cancer, Extended version- Consultation version 0.1","key":"ref38"},{"year":"2016","series-title":"Code of Medical Ethics of the Romanian College of Physicians from November 4, 2016","key":"ref39"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s00134-007-0975-6","article-title":"Recommendations on therapy limitation and therapy discontinuation in intensive care units: consensus paper of the Austrian Associations of Intensive Care Medicine","volume":"34","author":"Valentin A","year":"2008","journal-title":"Intensive Care Med"},{"year":"2012","series-title":"Human dignity, hospice care and euthanasia","key":"ref41"},{"year":"2016","series-title":"Code of Medical Ethics","key":"ref42"},{"issue":"8S","key":"ref43","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1097\/PCC.0000000000001606","article-title":"Notes on the development of the Slovenian ethical recommendations for decision-making on treatment and palliative care of patients at the end of life in intensive care medicine","volume":"19","author":"Grosek S","year":"2018","journal-title":"Pediatr Crit Care Med"},{"issue":"4","key":"ref44","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1007\/s11673-021-10128-w","article-title":"End-of-Life decisions in intensive care units in Croatia-pre covid-19 - perspectives and experiences from nurses and physicians","volume":"18","author":"Curkovic M","year":"2021","journal-title":"J Bioeth Inq"},{"year":"2016","series-title":"Code of medical ethics and deontology","key":"ref45"},{"issue":"1","key":"ref46","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1177\/0310057X1103900119","article-title":"End-of-life decisions in Hungarian intensive care units","volume":"39","author":"Zubek L","year":"2011","journal-title":"Anaesth Intensive Care"},{"issue":"4","key":"ref47","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/j.jpainsymman.2020.09.001","article-title":"Potentially inappropriate treatments at the end of life in nursing home residents: findings from the PACE cross-sectional study in six European countries","volume":"61","author":"Honinx E","year":"2021","journal-title":"J Pain Symptom Manage"},{"issue":"1","key":"ref48","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/BF03325207","article-title":"Starting artificial nutrition and hydration in patients with dementia in the Netherlands: frequencies, patient characteristics and decision-making process","volume":"19","author":"Van Wigcheren PT","year":"2007","journal-title":"Aging Clin Exp Res"},{"year":"2007","series-title":"Opinion n\u00ba 41 of 16 April 2007 on informed consent and \"D.N.R.\" Codes","key":"ref49"},{"issue":"1","key":"ref50","doi-asserted-by":"crossref","first-page":"111","DOI":"10.20452\/pamw.15746","article-title":"Discontinuation of hydration and nutrition in vegetative or minimally conscious state: position statement of the Polish Association for Spiritual Care in Medicine","volume":"131","author":"Pawlikowski J","year":"2021","journal-title":"Pol Arch Intern Med"},{"issue":"5","key":"ref51","first-page":"e401","article-title":"LAW n\u00ba 219\/17: reflecting on shared care plan","volume":"171","author":"Giammatteo J","year":"2020","journal-title":"Clin Ter"},{"issue":"3","key":"ref52","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.jpainsymman.2006.12.006","article-title":"Forgoing artificial nutrition or hydration in patients nearing death in six European countries","volume":"34","author":"Buiting HM","year":"2007","journal-title":"J Pain Symptom Manage"},{"issue":"4","key":"ref53","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1001\/jamainternmed.2015.7676","article-title":"Medical end-of-life practices in Switzerland: a comparison of 2001 and 2013","volume":"176","author":"Bosshard G","year":"2016","journal-title":"JAMA Intern Med"},{"year":"2013","series-title":"End-of-life care","key":"ref54"}],"container-title":["Revista Bio\u00e9tica"],"original-title":["Dimens\u00e3o \u00e9tica da alimenta\u00e7\u00e3o e hidrata\u00e7\u00e3o artificiais no doente terminal"],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S1983-80422024000100201&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T12:35:11Z","timestamp":1718368511000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S1983-80422024000100201&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024]]},"references-count":54,"alternative-id":["S1983-80422024000100201"],"URL":"https:\/\/doi.org\/10.1590\/1983-803420243604en","relation":{"has-translation":[{"id-type":"doi","id":"10.1590\/1983-803420243604pt","asserted-by":"subject"}]},"ISSN":["1983-8034","1983-8042"],"issn-type":[{"type":"electronic","value":"1983-8034"},{"type":"print","value":"1983-8042"}],"subject":[],"published":{"date-parts":[[2024]]},"article-number":"e3604PT"}}