Challenge Your Exam Readiness With Our Free Nutrition Support Clinician Practice Questions

Ethically sound nutrition care centers on respect for patient autonomy and previously expressed wishes. An advance directive refusing artificial nutrition should be honored unless there is clear evidence the patient’s preferences have changed while decisional capacity was intact. In advanced dementia, evidence shows limited benefit of PEG feeding on survival, aspiration pneumonia, pressure injury healing, or quality of life; risks include infection, restraints, and discomfort. The clinician’s role is to guide surrogate decision-makers using substituted judgment: decisions should reflect what the patient would have wanted, not simply what feels best to family. Comfort-focused care—e.g., careful hand feeding, treating thirst/dry mouth, minimizing burdensome interventions—aligns with beneficence and nonmaleficence. Transparent communication, documentation of goals-of-care, and interdisciplinary support (ethics consult, palliative care) help navigate conflict. Placing a PEG or PN against the directive undermines autonomy and may expose the patient to disproportionate harm without meaningful benefit.