NOV. 7,2023
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ETHICO-MORAL PRINCIPLES R/T TO
CULTURAL AND SPIRITUAL PREFERENCES
NUTRITIONAL GENOMICS
- Nutrigenomics
- science studying the relationship between human
genome, nutrition, and health
- Nutritional science: emerged as a field that studied
individuals lacking certain nutrients and the subsequent
effects
- Obesity: most widely studied in nutrigenomics
NUTRITIONAL SUPPORT AND END-OF-LIFE
DECISION MAKING
BURDENS AND BENEFITS OF NUTRITION
SUPPORT
BURDEN
a. Providing nutrition support to patients with
irreversible or terminal illnesses may not be beneficial.
b. 70 randomized controlled trials in cancer patients
showed no clinical benefits from nutrition support.
c. Nutrition support can lead to increasing suffering,
with symptoms like nausea, vomiting, bleeding, edema,
and infections, and may require patient restraint.
d. Some argue that withholding nutrition does not cause
pain and suffering, as brain areas responsible for pain
perception do not function in some cases.
e. Thirst and hunger are not significant problems for
patients who choose to forgo nutrition and hydration in
some studies.
f. Nurses caring for such patients have reported a better
quality of death compared to those continuously
receiving nutrition support.
g. Overall, for patients with irreversible or terminal
illnesses, nutrition support may not provide benefits and
may increase suffering while hastening death.
BENEFITS
a. Nutrition support benefits competent patients by
reducing physical deterioration and improving quality of
life.
[FINALS] LEC NO.
b. Tube feeding in progressive head and neck cancer
patients enhances nutrient intake, quality of life, and
fluid status.
c. Home nutrition support is essential for patients with
intestinal failure due to surgical removal or disease-
related gastrointestinal impairment.
d. Quality of life for advanced cancer patients on home
parenteral nutrition (HPN) is better when received for a
minimum of three months, considering life expectancy.
e. Approach to nutrition support at the end of life varies
based on the patient’s location (ICU, long-term care, or
home).
f. Ethical decisions in ICU involve integrating
philosophical principles with patient care and comfort.
g. Long-term care or home locations offer more
compassionate care, especially when provided by
caregivers familiar with the patient. Optimal end-of-life
care occurs in the patient’s home environment when
feasible.
DEBATE OVER HYDRATION
- Meticulous mouth care can minimize the need for
fluids in maintaining patient comfort
- water deprivation= trigger the body’s production of
endogenous opiates, potentially creating a euphoric state
and reducing pain
- Intravenous hydration can have negative effects on
quality of life by increasing pulmonary secretions,
urinary output, nausea, vomiting, and edema
- Managing dry mouth symptoms can be achieved
through the use of ice ships, lip balm, and moistened
swabs
GUIDELINES FOR APPROACHING NUTRITION
SUPPORT
1. Nutrition and hydration are life-sustaining medical
therapies that can be initiated or ceased, and the patient's
expressed desires should primarily guide these decisions.
2. Conversations about end-of-life issues should start
early in the diagnostic and treatment process, rather than
waiting until the dying process has begun.
3. Advance directives, which outline a patient's beliefs
and desires for end-of-life care, are ideal for
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documenting preferences, but only a minority of people
have them, and not all regularly review these documents.
4. When the patient is unable to make decisions, a family
member becomes a surrogate and must make decisions
based on the patient's values, which can be challenging if
there are differences in beliefs or family disagreements.
5. The typical sequence for withdrawing therapies may
not always align with the patient's goals and desires and
is often influenced by physician bias rather than patient-
centered care.
6. Clinicians often consider discontinuing nutrition
support when it is perceived as futile or ineffective for
the patient.
7. Quantifying futility can be challenging for patients
and their families, so clinicians should discuss the
appropriateness and benefits of the therapy.
8. If the patient's wishes are unclear or the family cannot
agree, it's important to continue discussions before
terminating therapy to avoid the perception of
abandonment.
9. The principle "When in doubt, don't take it out"
suggests erring on the side of caution.
10. Decisions regarding nutrition support at the end of
life should consider the patient's wishes, prognosis, and
therapy goals, with communication among the patient,
family, and healthcare providers being essential.
11. Open and honest communication is crucial for
making informed decisions, with the patient's autonomy
being the guiding factor.
12. Ongoing evaluation of the balance between the
benefit and burden of therapy should occur throughout
the treatment process.
SOCIAL, POLITICAL, AND ECONOMIC ISSUES
AND CONCERNS AFFECTING NUTRITION
CARE
-based on the review of the Food Security and Nutrition
in the Philippines (Briones, Antonio, Habito, Porio, and
Songco, 2017)
a. POLICY INCOHERENCE
- restrictive trade policies in rice → higher levels of
malnutrition in the country
[FINALS] LEC NO. 2
- pursuit of 100% rice self-sufficiency has driven
domestic rice prices significantly above global prices →
more expensive rice for consumers, particularly the poor
- Rice: crucial food item in Philippines
- Expensive rice → (-) impact to consumers → may have
implications for malnutrition
b. UNRESPONSIVE FOOD SYSTEM
- Trade distortions, inefficient logistics, postharvest
losses, and uncompetitive marketing practices contribute
to higher food prices in some regions
- rising food prices → affect poor consumers while also
reducing farm incomes
- Food prices tend to be more volatile compared to
general price levels
- Rapid food price inflation → (-) impact on nutritional
improvements
- Poor households find it more challenging to diversify
their diets, in part because retail prices for fruits and
vegetables have increased faster than other food items
since 2012
c. CLIMATE AND OTHER SHOCKS
- climate change is worsening existing vulnerabilities in
Philippine agriculture, food production, and vulnerable
populations
- expected to intensify by 2050 and beyond
- Frequent displacements of people due to conflict,
flooding, earthquakes, and disasters are common,
particularly affecting the poor and vulnerable who lack
resources and alternatives
- Evacuation centers further exacerbate the challenges
for these populations, as a result, malnutrition rates are
rapidly increasing in these affected areas.
d. PLANNING GAP
- often misses out in local programming and budgeting
e. GOVERNANCE AND SERVICE DELIVERY
GAPS
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- Food security and nutrition are complex, multi-
dimensional issues influenced by various interconnected
factors.
- Governance structures related to food security and
nutrition face challenges in coordinating efforts among
multiple agencies at both national and local levels.
- These structures often struggle with overlap, confusion,
and fragmentation of investments and actions by
different actors.
- Frontline workers, particularly Barangay Nutrition
Scholars, are often ill-equipped to handle households
with malnourished children in their communities, facing
tenure issues and difficult working conditions.
- Training outcomes are often not sustained due to high
worker turnover.
- The existing agricultural extension system under local
governments is inadequate, and its responsiveness to the
needs of small farmers and fishers requires review and
improvement.
f. LACK OF RESOURCES
- Resources allocated to address hunger and malnutrition
have been inadequate in relation to the scale of the
problem.
- Despite increased funding for food security and
nutrition (FSN) programs since around 2009, these funds
have often been diverted towards other social objectives
and have not significantly improved hunger and
malnutrition outcomes.
- Programs specifically aimed at combating hunger and
malnutrition have been underfunded, particularly at the
local level.
- Ineffectiveness and stand-alone programs, like school-
based feeding, may have resulted in the wastage of a
significant portion of funds allocated for FSN (Food
security and nutrition)
g. IMPLEMENTATION GAPS
- Numerous programs and interventions exist to tackle
hunger and malnutrition in the country, but they have
proven insufficient to address the problems effectively.
- Some government interventions, such as micronutrient
fortification, suffer from low compliance.
[FINALS] LEC NO. 2
- Key nutrition interventions, like the First 1,000 days,
often become just one of many health promotion and
service delivery activities undertaken by frontline health
workers.
- Large-scale supplementary feeding programs are hard
to sustain without external support and may have unclear
impacts on children’s nutritional status.
- Rice subsidies are poorly targeted, with benefits often
leaking to non-poor individuals.
h. WEAK ACCOUNTABILITY
- Accountability for addressing hunger and malnutrition
is currently dispersed, and this dispersion limits the
effectiveness of efforts.
- Strong government push for accountability = to raise
awareness about the issue and prioritize solutions.
- Local officials in areas with poor hunger and
malnutrition indicators might be motivated to invest in
food security and nutrition programs to achieve better
results.
- Similarly, at the national level, agency heads may be
prompted to align their sectoral goals when held
accountable for their contributions to solving the
overarching problem of worsening hunger and
malnutrition
i. OTHER ISSUES
- Various factors affecting maternal and child nutrition,
with a focus on social, political, and economic
influences, as well as socio-cultural factors like religion
and food. The main points are:
1. Purpose: to help vulnerable women and their families
access adequate nutrition by addressing barriers through
health policies, referrals, advocacy, and individual
actions.
2. Objectives for informed professionals:
a. recognizing key barriers to adequate nutrition,
understanding research and statistical data on nutrition
and hunger
b. knowing WHO and USA nutrition policy objectives
c. being aware of food and nutrition resources in their
community
3. Poverty is a major socio-economic cause of nutrient
intake variation, impacting both intake and requirements.
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NOV. 7,2023 [FINALS] LEC NO. 2
It leads to living in less food-secure environments with
potential health risks.
4. Parasites and diseases, such as hookworms and
malaria, are more prevalent in poor environments and
increase nutrient needs due to blood loss.
5. Socio-cultural factors, like religion, food, and social
status, influence what people eat and the nutrients they
require.
6. Religion and culture affect food choices and nutrient
consumption, influencing what is considered edible and
which nutrients are needed in larger quantities.

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