Ethics of Care: A Perspective on Nutrition in Advanced Cancer

Monica de Oliveira Benarroz; Rocio Fernandez Santos Viniegra; Edna Corrêa Moreira; Rodrigo  Siqueira-Batista

doi:10.14422/rib.i28.y2025.001

Autores/as

Monica de Oliveira Benarroz Universidade Federal do Rio de Janeiro https://orcid.org/0000-0001-7416-1489
Rocio Fernandez Santos Viniegra Universidade Federal Fluminense https://orcid.org/0000-0002-0662-408X
Edna Corrêa Moreira Hospital Universitário Gaffrée e Guinle https://orcid.org/0000-0001-8105-3961
Rodrigo Siqueira-Batista Universidade Federal de Viçosa https://orcid.org/0000-0002-3661-1570

DOI:

https://doi.org/10.14422/rib.i28.y2025.001

Palabras clave:

Advanced cancer, dietitian, ethics of care, nutrition, palliative care

Resumen

Nutrition-related problems are common in advanced cancer but are not always properly identified and treated. Food is highly symbolic, establishing a strong connection to life and well-being. The inability to eat and drink is associated with disease progression and death. Nutritional care is the most effective way to address these issues through responsible, conscientious, and compassionate support. In both the ethics of care and palliative care, the relationship and commitment to vulnerable individuals are integral to daily health practices. Through the lens of the ethics of care, we argue that nutritional care provided by dietitians is crucial in palliative care to address nutrition-related issues, resolve moral conflicts and dilemmas, and prevent an increase in vulnerabilities and violations of the rights of patients and families.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

Amano, K., Baracos, V. E., & Hopkinson, J. B. (2019). Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members. Critical Reviews in Oncology/Hematology, 143, 117-123. https://doi.org/10.1016/j.critrevonc.2019.08.006

Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., Fearon, K., Hütterer, E., Isenring, E., Kaasa, S., Krznaric, Z., Laird, B., Larsson, M., Laviano, A., Mühlebach, S., Muscaritoli, M., Oldervoll, L., Ravasco, P., Solheim, T., Strasser, F., de van der Schueren, M., & Preiser, J. C. (2017). ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 36(1), 11-48. https://doi.org/10.1016/j.clnu.2016.07.015

Arendt, H. (1999). Eichmann em Jerusalém: um relato sobre a banalidade do mal. Companhia das Letras.

Benarroz, M. O., Faillace, G. B. D., & Barbosa, L. A. (2009). Bioética e nutrição em cuidados paliativos oncológicos em adultos. Cadernos de Saúde Pública, 25(9), 1875-1882. https://doi.org/10.1590/s0102-311x2009000900002

Benarroz, M. O., Scapulatempo, H. H., Mendes, E. C., & Santos, A. P. M. B. (2019). Anorexia: an eating challenge in palliative care. Rev. Bras. Cancerol., 65(2), e-11098. https://doi.org/10.32635/2176-9745.RBC.2019v65n2.98

Boff, L. (2014). Saber cuidar (20.ª ed.). Vozes.

Cardenas, D., & Pelluchon, C. (2016). The Ethical Foundations of Nutritional Care: A viewpoint on the recent ESPEN guidelines. Clinical Nutrition, 35(6), 1587-1588. https://doi.org/10.1016/j.clnu.2016.09.014

Cardenas, D., Correia, M. I. T. D., Ochoa, J. B., Hardy, G., Rodriguez-Ventimilla, D., Bermúdez C. E., Papapietro, K., Hankard, R., Briend, A., Ungpinitpong, W., Zakka, K. M., Pounds, T., Cuerda, C., & Barazzoni, R. (2021). Clinical nutrition and human rights. An international position paper. Clinical Nutrition, 40(6), 4029-4036. https://doi.org/10.1016/j.clnu.2021.02.039

Cipriano-Crespo, C., Conde-Caballero, D., Rivero-Jiménez, B., & Mariano-Juárez, L. (2021). Eating experiences and quality of life in patients with larynx cancer in Spain. A qualitative study. International Journal of Qualitative Studies on Health and Well-being, 16(1). https://doi.org/10.1080/17482631.2021.1967262

Conklin, A. I., Forouhi, N. G., Surtees, P., Khaw, K. T., Wareham, N. J., & Monsivais, P. (2014). Social relationships and healthful dietary behaviour: evidence from over-50s in the EPIC cohort, UK. Social Science & Medicine, 100, 167-175. https://doi.org/10.1016/j.socscimed.2013.08.018

Cortina, A. (2016). Bioética para el siglo XXI: construyendo esperanza. Revista Iberoamericana de Bioética, (1), 1-12. https://doi.org/10.14422/rib.i01.y2016.001

Costa, M. F., & Soares, J. C. (2016). Alimentar e nutrir: sentidos e significados em cuidados paliativos oncológicos. Rev. Bras. Cancerol., 62(3), 215-224. https://doi.org/10.32635/2176-9745.RBC.2016v62n3.163

Edwards, S. D. (2009). Three versions of an ethics of care. Nursing Philosophy, 10(4), 231-240. https://doi.org/10.1111/j.1466-769X.2009.00415.x

Erickson, N., Sullivan, E. S., Kalliostra, M., Laviano, A., & Wesseling, J. (2023). Nutrition care is an integral part of patient-centred medical care: a European consensus. Medical Oncology, 40(4), 112. https://doi.org/10.1007/s12032-023-01955-5

Fischler, C. (1988). Food, self and identity. Social Science Information, 27(2), 275-292. https://doi.org/10.1177/053901888027002005

Francisco. S., & Girard, J. (2020). Le devoir de (re)penser les soins palliatifs. Revue de la Société Suisse de Médecine et de Soins Palliatifs, 3, 52-54.

Glasdam, S., Jacobsen, C. B., & Boelsbjerg, H. B. (2020). Nurses’ refusals of patient involvement in their own palliative care. Nursing Ethics, 27(8), 1618-1630. https://doi.org/10.1177/0969733020929062

Gombert, K., Douglas, F., Carlise, S., & Mcardle, K. (2017). A capabilities approach to food choices. Food Ethics, 1, 143-155. https://doi.org/10.1007/s41055-017-0013-5

Gómez-Batiste, X., & Connor, S. (eds.). (2017). Building integrated palliative care programs and services. Liberdúplex. https://www.researchgate.net/publication/317258932

Held, V. (2006). The Ethics of Care: Personal, Political, and Global. Oxford University Press. https://doi.org/10.1093/0195180992.001.0001

Hétu, D. (2018). Les éthiques du care. Regards critiques dans les sciences humaines et sociales. Temps zéro, 12. http://tempszero.contemporain.info/document1645

Higgs, S., & Thomas, J. (2016). Social influences on eating. Current Opinion in Behavioral Sciences, 9, 1-6. https://doi.org/10.1016/j.cobeha.2015.10.005

Hopkins, K. (2004). Food for life, love and hope: an exemplar of the philosophy of palliative care in action. Proceedings of the Nutrition Society, 63(3), 427-429. https://doi.org/10.1079/pns2004372

Hopkinson, J. B. (2016). Food connections: A qualitative exploratory study of weight- and eating-related distress in families affected by advanced cancer. European Journal of Oncology Nursing, 20, 87-96. https://doi.org/10.1016/j.ejon.2015.06.002

Hui, D., & Bruera, E. (2016). Integrating palliative care into the trajectory of cancer care. Nature Reviews Clinical Oncology, 13(3), 159-171. https://doi.org/10.1038/nrclinonc.2015.201

Imtiyaz, H., Soni, P., & Yukongdi, V. (2021). Investigating the Role of Psychological, Social, Religious and Ethical Determinants on Consumers’ Purchase Intention and Consumption of Convenience Food. Foods, 10(2), 237. https://doi.org/10.3390/foods10020237

Kaplan, E. B. (2000). Using Food as a Metaphor for Care: Middle-School Kids Talk about Family, School, and Class Relationships. Journal of Contemporary Ethnography, 29(4), 474-509. https://doi.org/10.1177/089124100029004003

Lacey, K., & Pritchett, E. (2003). Nutrition care process and model: ADA adopts a road map to quality care and outcomes management. Journal of the American Dietetic Association, 103(8), 1061-1072. https://doi.org/10.1016/s0002-8223(03)00971-4

Liposits, G., Orrevall, Y., Kaasa, S., Österlund, P., & Cederholm, T. (2021). Nutrition in cancer care: a brief, practical guide with a focus on clinical practice. JCO Oncology Practice, 17(7), e992-e998. https://doi.org/10.1200/OP.20.00704

Lorton, C. M., Griffin, O., Higgins, K., Roulston, F., Stewart, G., Gough, N., Barnes, E., Aktas, A., & Walsh, T. D. (2020). Late referral of cancer patients with malnutrition to dietitians: a prospective study of clinical practice. Support Care Cancer, 28(5), 2351-2360. https://doi.org/10.1007/s00520-019-05042-2

Muscaritoli, M., Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., Hütterer, E., Isenring, E., Kaasa, S., Krznaric, Z., Laird, B., Larsson, M., Laviano, A., Mühlebach, S., Oldervoll, L., Ravasco, P., Solheim, T. S., Strasser, F., de van der Schueren, M., Preiser, J. C., & Bischoff, S. C. (2021). ESPEN practical guideline: Clinical Nutrition in cancer. Clinical Nutrition, 40(5), 2898-2913. https://doi.org/10.1016/j.clnu.2021.02.005

Panfilis, L. de, di Leo, S., Peruselli, C., Ghirotto, L., & Tanzi, S. (2019). “I go into crisis when …”: ethics of care and moral dilemmas in palliative care. BMC Palliat Care, 18. https://doi.org/10.1186/s12904-019-0453-2

Pinho, N. B., Martucci, R. B., Rodrigues, V. D., D’Almeida, C. A., Thuler, L. C. S., Saunders, C., Jager-Wittenaar, H., & Peres, W. A. F. (2019). Malnutrition associated with nutrition impact symptoms and localization of the disease: Results of a multicentric research on oncological nutrition. Clinical Nutrition, 38(3), 1274-1279. https://doi.org/10.1016/j.clnu.2018.05.010

Saramago, J. (1995). Ensaio sobre a cegueira. Cia das Letras.

Saunders, C., Baines, M., & Dunlop, R. (1995). Living with dying: A guide to palliative care (3.ª ed.). Oxford University Press. https://doi.org/10.1093/acprof:oso/9780192625144.001.0001

Tronto, J. (1993). Moral Boundaries, a Political Argument for an Ethic of Care. Routledge.

Tronto, J. (2007). Assistência democrática e democracias assistenciais. Sociedade e Estado, 22(2), 285-308. https://doi.org/10.1590/S0102-69922007000200004

United Nations Educational, Scientific and Cultural Organization (UNESCO). (2009). Universal Declaration on Bioethics and Human Rights. https://unesdoc.unesco.org/ark:/48223/pf0000179844

World Health Organization (WHO). (2003). Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation. https://www.who.int/publications/i/item/924120916X