To feed or to care? Nutritional support in palliative care from a personalist bioethics perspective
Abstract
In the context of palliative care, nutritional decisions involve the challenge of assessing the therapeutic proportionality of nutritional interventions, discerning when nutrition constitutes an act of care consistent with respect for the person's dignity and quality of life, and when its implementation or withdrawal may result in interventions that are disproportionate to the expected benefits. This article reflects on the role of nutrition in palliative care from the perspective of personalist bioethics, which recognizes the inherent dignity of the person and prioritizes the integral care of human life. It also examines the professional responsibility of the nutrition professional in decision-making processes oriented toward quality of life, respect for patient autonomy, and empathetic communication with patients and their families. Finally, the article proposes ethical guidelines to promote a humanized nutritional practice consistent with the principles of therapeutic proportionality, beneficence, and respect for human dignity.
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References
Araújo, C. Á., de Melo, R. F. B. P., Sant Anna, G. & Amorim, F. F. (2025). Nutrition in palliative care at the end of life: Bibliometric and network analysis until 2024. Medicine, 104(29), e43381. https://doi.org/10.1097/MD.0000000000043381
Bozzetti, F. (2020). Is there a place for nutrition in palliative care? Supportive Care in Cancer. https://doi.org/10.1007/s00520-020-05505-x
Cassell, E. (2010). Sufrimiento. En Walsh D. Medicina paliativa. Elsevier.
Cederholm, T., Barazzoni, R., Austin, P., Ballmer, P., Biolo, G., Bischoff, S. C., Compher, C., Correia, I., Higashiguchi, T., Holst, M., Jensen, G. L., Malone, A., Muscaritoli, M., Nyulasi, I., Pirlich, M., Rothenberg, E., Schindler, K., Schneider, S. M., de van der Schueren, M. A. E., … & Singer, P. (2017). ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical Nutrition, 36(1), 49–64. https://doi.org/10.1016/j.clnu.2016.09.004
Clark, J. B. & Batten, L. S. (2024). Nutrition and Hydration in Palliative Care and Their Diverse Meanings. In R. D. MacLeod & L. van den Block (Eds.), Textbook of Palliative Care (pp. 1773–1790). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-48991-4_117
de Antueno, P. & Silberberg, A. (2018). Eficacia de los cuidados paliativos en el alivio del sufrimiento. Bioética en práctica, 22, 367-380. https://doi.org/10.5294/pebi.2018.22.2.12
de la Garza, A. L. & Zonenszain-Laiter, Y. (2022). Unidad, individualidad y unicidad de la persona en el balance riesgos/beneficios del uso de las pruebas nutrigenéticas en la práctica clínica. Acta Bioethica, 28(2). https://www.scielo.cl/pdf/abioeth/v28n2/1726-569X-abioeth-28-02-215.pdf
de la Garza, A. L. & Zonenszain-Laiter, Y. (2023). Análisis bioético del uso de la biotecnología genómica en la nutrición traslacional. Persona y Bioética, 26(2), 1–13. https://doi.org/10.5294/pebi.2022.26.2.4
de Siqueira, J. E. (2001). El principio de responsabilidad de Hans Jonas. Acta Bioethica, 7(2), 277-85. http://dx.doi.org/10.4067/S1726-569X2001000200009
Dietrich, L. (2004). La libertad humana como valor primordial en Tomás de Aquino. Teología y Vida, XLV, 531–538. http://dx.doi.org/10.4067/S0049-34492004000400003
Druml, C., Ballmer, P. E., Druml, W., Oehmichen, F., Shenkin, A., Singer, P., Soeters, P., Weimann, A. & Bischoff, S. C. (2016). ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clinical Nutrition, 35(3), 545–556. https://doi.org/10.1016/j.clnu.2016.02.006
Fayos, R. (2014). Bioética personalista en el pensamiento de Romano Guardini. Cuadernos de Bioética, 25(83), 159–168. https://aebioetica.org/revistas/2014/25/83/159.pdf
Holdoway, A. (2022). Nutrition in palliative care: issues, perceptions and opportunities to improve care for patients. British Journal of Nursing, 31, S20–S27. https://doi.org/10.12968/bjon.2022.31.21.S20
Kavalieratos, D., Corbelli, J., Zhang, D., Dionne-Odom, J. N., Ernecoff, N. C., Hanmer, J., Hoydich, Z. P., Ikejiani, D. Z., Klein-Fedyshin, M., Zimmermann, C., Morton, S. C., Arnold, R. M., Heller, L. & Schenker, Y. (2016). Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis. JAMA, 316(20), 2104-2114. https://doi:10.1001/jama.2016.16840
Koithan, M. & Taylor-Swanson, L. (2025). Whole person symptom management: Adapting a palliative care approach across patient populations. EXPLORE, 21(6), 103244. https://doi.org/10.1016/j.explore.2025.103244
Kuthy, J., Villalobos, J. de J., Martínez, O. & Tarasco, M. (2015). Introducción a la Bioética (4a ed.). Méndez Editores.
Roqué, M. V., Macpherson, I. & Gonzalvo, M. (2015). El principio de precaución y los límites en biomedicina. Persona y Bioética. 19(1),129-39. https://doi.org/10.5294/pebi.2015.19.1.10
Shippee, T., Shippee, N., Fernstrom, K., Mobley, P., Frazer, M., Jou, J. & Britt, H. (2017). Quality of Life for Late Life Patients: Mixed-Methods Evaluation of a Whole-Person Approach for Patients with Chronic Illnesses. Journal of Applied Gerontology, 38(7), 910–930. https://doi.org/10.1177/0733464817732511
Spaemann, R. (1997). ¿Es todo ser humano una persona? Persona y Derecho, (37), 9-24. https://hdl.handle.net/10171/12929
Stoian, M., Stoian, A., Bănescu, C., Bandila, S. R., Babă, D. F., & Azamfirei, L. (2025). Nutrition and Hydration at the End of Life in Intensive Care and General End-of-Life Care Settings: Balancing Clinical Evidence, Patient-Centered Care, and Ethical and Legal Principles—A Narrative Review. Nutrients, 17(23). https://doi.org/10.3390/nu17233705
Zapata-Ospina, J. P. (2019). La responsabilidad: un principio para retomar en la reflexión bioética. Iatreia, 32(4), 338–345. https://doi.org/10.17533/udea.iatreia.30
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