Client Preference

The most important ethical principle to consider is the client’s right to self-determination. Some
individuals may perceive suffering as an important means of personal growth or a religious
experience. Other individuals may hope a miracle cure will be discovered for his or her disease.
Other may be ready for and accepting or death. Health-care workers have a responsibility to provide
a combination of emotional support and technical nutritional advice on how best to achieve each
client’s goals.

Quality of life

The most fundamental goal of medical care is an improvement in the quality or life for those who
seek care. If improvement is not possible, a goal of medical care is maintenance of the same quality
of life or slowing a decline in quality of life. Oral feeding is part of being human and associated with
human dignity. One study found that 92% of all cancer clients could eat or drink until the day they
died (Feuz and Rapin, 1994). These clients derived some pleasure from the sensual aspect of food
and the socialization that accompanies meals. Food conveys :

 Emotional
 Spiritual
 Sociological, and
 Biological meanings

If food remains enjoyable for a client with a terminal illness, the health-care worker should
encourage mealtimes to be shared with loved ones. If eating is not a pleasant experience, however,
it should not be overemphasized.

Contextual

Every terminally ill client has his or her own story, with both a history and future. A client’s decision
to eat or not to eat is part of his or her narrative. Two examples can illustrate why eating issues
should always be given consideration when formulating a care plan.

Client 1 lives in a rooming house without air conditioning; his family does not want to get involved;
he does not have cooking facilities; he refuses to eat the meals delivered to him from the Senior
Nutrition Center; and he insist that he wants to die at home. Client 1 refuses to eat.

Client 2 lives with his male companion in a beach house; his friend carries him every day to the
beach to watch the sunset; meals are prepared for him by his companion and many other neighbors
and friends. Client 2 tries to eat a small amount at least six times a day.

The willingness to eat is part of each man’s story. The contextual features in a patient’s situation
often relate to food acceptance. In Client 1’s situation, the health-care worker may offer a valuable
service by reassuring the client that he will not be abandoned because he refuses to eat. The fear of
abandonment is among the most frequently cited apprehensions of dying. Even if a client refuses to
eat, health-care workers should remain supportive. The client may change his or her mind. The
health-care worker should not consider the rejection of food as a sign of personal or professional
failure.

A consideration of a client’s medical goals, preferences, quality of life, and contextual features may
provide a framework for resolution of ethical dietary issues. Hospice programs have interdisciplinary
care teams, and the interdisciplinary team conference is the best arena in which to discuss ethical
feeding conflicts.