Oral feeding difficulties and dilemmas: a guide to practical care, particularly towards the end of life

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A revised guideline will be published Autumn 2020.

Endorsed by the Association of British Neurologists, British Association for Parenteral and Enteral Nutrition, British Dietetic Association, British Geriatrics Society, Royal College of Nursing and the Royal College of Speech and Language Therapists.

Feeding is basic to life but it can also be an artificial medical procedure in the power of health professionals. Sometimes it causes dilemmas and strong differences of opinion between patients, relatives and professionals. This report is the result.

It acknowledges the confusion and uncertainty that sometimes surrounds decision-making and practice, including the difficulties of carrying out some of the technical interventions involved.

The report provides evidence-based guidance on the mechanisms and techniques of oral and artificial nutrition in health and disease. It sets out the ethical and legal concerns that provide the framework for decision-making. Case studies then illustrate dilemmas and solutions, for example on deciding whether to withhold or provide artificial nutrition.

The report, which is available to purchase or download as a pdf, is essential reading for all those involved in caring for people who have nutritional and oral feeding difficulties, including gastroenterologists, ward nurses, geriatricians, dieticians, speech therapists, neurologists, care home and community nurses, as well as carers, family and the patients themselves.


  • Recommendations
  • Background: oral feeding
  • Clinical issues
  • Oral feeding problems in different conditions
  • Assessment
  • Management
  • Strategies
  • Techniques of artificial nutrition
  • Enteral nutrition
  • Nasogastric versus gastrostomy feeding
  • Parenteral nutrition
  • Feeding techniques
  • General nursing care
  • Ethics
  • Ethical principles
  • Sanctity of life
  • Withholding and withdrawing
  • Best interests
  • Euthanasia
  • Killing and letting die
  • Law
  • Capacity
  • Duty to provide 'basic care'
  • How are 'best interests' determined?
  • Advance decisions
  • When to go to court
  • Practice
  • Teams and responsibility
  • Specific medical conditions
  • Who decides if the patient cannot decide?
  • Dealing with disagreement
  • Principles of practical management

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