Abstract
Institutional palliative care is gaining prominence in Taiwan. In our nursing home, we regularly conduct family meetings to deliberate on the ongoing care plans for new residents, particularly when their clinical conditions deteriorate. A 77-year-old male resident in our nursing home encapsulates the multifaceted challenges in end-of-life care and nutritional management. With a complicated history of cerebrovascular accident, dysphagia with nasogastric tube insertion, type 2 diabetes mellitus with chronic kidney disease, and dementia, he exhibited distressing symptoms leading to recurrent hospitalizations. Upon the patient’s wife request to cease feeding, we held a palliative care family meeting. The primary focus was to address end-stage illness management, elucidate the prognosis, confirm the direction of ongoing care, and elaborate the differences between palliative care and terminal fasting. The discussion covered nutritional requirements, emphasizing protein supplementation, body weight maintenance, and ethical considerations of voluntarily stopping eating and drinking (VSED), particularly in non-verbal patients. The team explored whether the choice of terminal fasting, proposed due to an unrecoverable stroke compounded by financial constraints, equates to expediting the patient’s demise. The challenges of evaluating the condition of non-verbal palliative patients were also emphasized. The investigation focused on the complexities of nutritional care in terminally ill patients, emphasizing the ethical considerations of VSED in palliative care. This case underscores the fine balance between providing essential nutritional support, understanding ethical dimensions of terminal fasting, and assessing the needs and conditions of non-verbal patients within palliative care. To engage diverse perspectives, an interdisciplinary team, including palliative care specialists, nurses, dietitians, pharmacists, caregivers, social workers and family members, aimed to provide crucial insights and guidance on complex nutritional requirements and ethical dilemmas in terminal cases. Active involvement of patients' families and caregivers through Personal and Public Involvement (PPI) was crucial. The outcomes deepened our understanding of the delicate balance between nutritional support and ethical considerations in end-of-life care, particularly for non-verbal patients. Ultimately, the families opted for the resident to receive institutional palliative care, allowing us to make necessary adjustments to medication and diet based on professional expertise. During our practice, we have encountered situations where certain families face challenges in making medical decisions for their loved ones who have lost the ability to express themselves. In addition to collaborating with families to determine the most suitable care for residents, we actively promote advanced care planning (ACP) to both residents and their families. Our goal is to empower individuals to articulate preferences and wishes, enabling them to live life on their own terms even as they approach the end of life. We believe in facilitating a meaningful and personalized journey towards a dignified death for everyone involved.