Cure, Care, Compare, And Contrast: Basic Care, Nutrition, Hy

Cure Care Compare And Contrast2 Basic Care Nutrition Hydrati

Compare and contrast cure and care in healthcare practices. Basic care encompasses fundamental human needs such as nutrition, hydration, shelter, and human interaction, raising questions about moral obligations towards providing these needs and the ethical considerations involved. Additionally, the document explores specific medical procedures like swallow tests, indications for medically assisted nutrition and hydration, and detailed descriptions of enteral and parenteral nutrition methods. A bioethical analysis of nutrition and hydration discusses the core principles guiding end-of-life care, including the basic principle and two notable exceptions. The case study of Terry Schiavo offers a real-world context for applying ethical reasoning in complex medical and end-of-life decisions.

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Healthcare practices encompass a broad spectrum of interventions, among which the distinction between cure and care is fundamental. Cure typically refers to medical interventions aimed at eradicating disease or restoring health through procedures, medications, surgeries, or other curative treatments. Care, in contrast, emphasizes holistic support for patients, focusing on comfort, emotional well-being, dignity, and quality of life—particularly when curative measures are no longer effective or appropriate (Foucault, 1973). While cure aims at physically restoring health, care prioritizes human dignity and compassionate support, often involving palliative approaches. Both are essential components of healthcare but serve different primary objectives, prompting ethical debates on their application and prioritization (Nordenfelt, 2000). The moral obligations entwined with providing basic care—nutrition, hydration, shelter, and human interaction—are rooted in principles of human rights and dignity. Many ethicists argue that society has a moral obligation to ensure these fundamental needs are met, as neglect constitutes a violation of basic human rights (Beauchamp & Childress, 2013). Ethical frameworks like the principle of beneficence and respect for persons reinforce the duty to provide adequate care, especially for vulnerable populations such as the elderly or terminally ill individuals (World Medical Association, 2013).

The importance of swallow tests, or bedside assessments, becomes evident in assessing a patient’s ability to swallow safely, particularly among stroke survivors or those with neurological impairments. A swallow test involves observing a patient’s ability to swallow small amounts of water or food, checking for signs of aspiration such as coughing or choking (Hinrichsen et al., 2014). It is indicated when there is concern about dysphagia—difficulty swallowing—to prevent aspiration pneumonia, which can be life-threatening (Barthelemy & O’Connor, 2020). When oral intake is deemed unsafe or inadequate, medically assisted nutrition and hydration (N/H) are appropriate. These measures are essential in maintaining hydration and nutrition when patients cannot meet their needs independently, especially in cases involving coma or severe neurological impairment (Miller et al., 2018).

Enteral nutrition (EN), a method of providing nutrients directly into the gastrointestinal tract, includes different techniques such as Nasoduodenal (NJ) and Naso-gastric (NG) tubes, as well as Percutaneous Endoscopic Gastrostomy (PEG). The NG tube is inserted through the nose into the stomach, suitable for short-term feeding (Lacruz et al., 2017). The NJ tube passes beyond the stomach into the small intestine, used when gastric feeding is contraindicated or poorly tolerated (Huang et al., 2019). PEG involves surgically inserting a tube directly into the stomach through the abdominal wall and is generally used for long-term nutritional support (Dorr & Brown, 2014).

Parenteral nutrition (PN) provides nutrients intravenously when the gastrointestinal tract cannot be used. Total Parenteral Nutrition (TPN) delivers all nutritional needs via central venous access, suitable for severe gastrointestinal dysfunction (Huang & Hendricks, 2018). Partial Parenteral Nutrition (PPN) supplies some nutritional requirements and may be administered via peripheral veins for less extensive needs or short-term use (Gordon et al., 2020).

A bioethical analysis of nutrition and hydration centers on the principle of beneficence, non-maleficence, autonomy, and justice. These principles guide decisions about whether to initiate, withdraw, or withhold artificial nutrition and hydration. Respecting patient autonomy involves honoring the wishes of competent individuals, including refusal of artificial support (Beauchamp & Childress, 2013). However, exceptions exist, particularly when the patient’s expressed wishes are unknown, or their decision might lead to disproportionate suffering or violate the principle of beneficence. For instance, providing artificial nutrition might be considered ethically obligatory if it sustains life without causing undue harm, but refusing treatment might be justified when it prolongs suffering or if the perceived benefit is minimal (Tao et al., 2012).

The case of Terry Schiavo encapsulates complex ethical dilemmas involving end-of-life decision-making, autonomy, quality of life, and the moral responsibilities of healthcare providers and families. Schiavo’s case questioned whether artificial nutrition and hydration constitute extraordinary means or basic care and whether their withdrawal constitutes euthanasia (Capron, 2005). The ethical debate hinged on respecting her prior wishes, her current best interests, and the roles of legal and medical authorities. It underscores the importance of advance directives and the necessity of clear communication about end-of-life preferences (Fischer & Möller, 2006). Ultimately, Schiavo’s case highlights the need for ethical frameworks to guide difficult decisions surrounding life-sustaining treatments, respecting autonomy while considering beneficence and non-maleficence.

In conclusion, the distinction between cure and care emphasizes different yet interconnected approaches in healthcare, both driven by moral obligations grounded in human dignity. Providing basic needs like nutrition and hydration is ethically imperative, particularly in vulnerable populations, guided by principles of beneficence and respect for autonomy. Medical procedures such as swallow tests and artificial nutrition methods are critical tools in patient management, especially in end-of-life care. Ethical decision-making in these contexts requires balancing respect for autonomy with beneficence and non-maleficence, exemplified by cases like Terry Schiavo, illustrating the profound moral responsibilities healthcare providers and families face in care decisions.

References

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  • World Medical Association. (2013). WMA Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. Journal of the American Medical Association, 310(20), 2191–2194.

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