| Course | NS490 Medical Nutrition Therapy II |
|---|---|
| Unit | Unit 8 |
| Paper type | Ethics position paper |
| Length | About 1,150 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BS in Nutrition Science |
| Updated | October 2026 |
Free sample paper for NS490 Unit 8
A Time-Limited Trial, Not a Promise: A Unit 8 Ethics Position Paper on Home Parenteral Nutrition for Inoperable Malignant Bowel Obstruction
[Student Name]
Purdue University Global
NS490: Medical Nutrition Therapy II
Unit 8 Ethics Position Paper
[Instructor Name]
[Date]
The patient, her family and her team are composite; the cancer nutrition guideline, the ethics guideline and the survival meta-analysis cited are real.
The Case
Celia, 58, a retired school librarian, has recurrent ovarian cancer with an inoperable malignant bowel obstruction. A venting gastrostomy relieves her vomiting, but she can take only sips of liquid, and nothing she drinks is absorbed. She is weak but walks around her house, manages her own care and is clear about her wishes. Her oncologist estimates she may live two to four months. Without nutrition, her team expects she would decline faster from starvation than from the cancer itself. Celia has asked for home parenteral nutrition. Her husband supports her but fears the work of daily infusions. Her oncologist worries that intravenous feeding will add infections and hospital visits to her last months.
Position
Celia should be offered a time-limited trial of home parenteral nutrition, with goals she has stated, a review date and stopping criteria agreed in advance. The trial respects her autonomy and her specific goal, fits current guidance for carefully selected patients, and keeps the option of stopping open and honest.
Ethical Framework
Artificial nutrition is a medical treatment, not basic care. The ethics guideline on artificial nutrition states that it requires a medical indication and the informed consent of the patient, and that it may be withheld or withdrawn when it no longer serves the patient's goals (Druml et al., 2016). This frames the question correctly: not whether Celia must be fed, but whether this treatment can achieve something she values at an acceptable cost.
Argument 1: The Evidence Supports It for Patients Like Celia
The cancer nutrition guideline suggests that parenteral nutrition may be offered to patients with chronic intestinal failure from incurable cancer, including malignant bowel obstruction, when enteral nutrition is not possible, survival is expected to exceed a few months, and the patient wants it (Arends et al., 2017). Celia meets each of these conditions. She cannot absorb food by mouth or tube, her expected survival is in that range, her performance status is reasonable and she is asking for it.
Argument 2: Her Goal Is Specific and Time-Bound
Celia's goal is not to live indefinitely but to reach a specific event in three months. A meta-analysis of home parenteral nutrition in patients with inoperable malignant bowel obstruction found a median survival of 83 days, with 45 percent alive at three months (Naghibi et al., 2015). That does not guarantee she will reach the wedding, but it makes her goal possible rather than unrealistic, and a trial can be judged against it.
The Strongest Objection
The strongest case against home feeding is that, for many patients like Celia, it adds infections, hospital visits and daily burden to a short life, and that the same meta-analysis found high costs and quality of life that often worsened before death.
Her oncologist's concern is grounded in evidence. Central lines can become infected, infusions take hours each day, and her husband would carry much of the work. The meta-analysis reported a high cost per quality-adjusted life year and limited evidence that quality of life improved (Naghibi et al., 2015). Starting a treatment that may prolong dying without improving living is a real risk.
Response to the Objection
The objection argues for careful selection and honest limits, not for refusal. Three features of a time-limited trial answer it. First, the goals are hers and are written down: attending the wedding and staying at home. Second, the review date, at four weeks and again before the wedding, forces an honest assessment of whether the treatment is serving those goals. Third, the stopping criteria are agreed now, while she can decide: recurrent line infection, rapid decline in function, a hospitalization caused by the feeding, or her own request. If the burdens outweigh the benefits, stopping becomes the plan working as designed rather than a failure.
The burden on her husband is also real. A home infusion nurse, training before discharge and a clear plan for help at night make the trial possible; if he cannot manage after support is in place, that becomes a reason to reconsider.
Argument 3: Declining Is Also a Decision With Consequences
Refusing the trial is sometimes framed as the cautious choice, but it is not neutral. Celia cannot absorb anything by mouth, so without parenteral support her team expects her to weaken within weeks, well before the cancer itself would be expected to end her life. Choosing not to feed her would therefore set the timeline of her death, and it would do so against her stated wish. The ethics guideline treats withholding and withdrawing as morally equivalent when both follow the patient's goals and a careful judgment of benefit (Druml et al., 2016). That equivalence cuts both ways: if stopping later is acceptable, starting now with a plan to stop is no less ethical than never starting at all.
If Celia Loses Capacity
Her disease may bring periods of confusion from dehydration, infection or medication. The plan should therefore name her husband as her health care agent and record, in her own words, what she would want if the trial stops meeting its goals. Her written stopping criteria then guide him and the team, so the decision does not fall to him alone at a frightening moment. Hydration and comfort measures, including mouth care, antiemetics and the venting tube, continue whether or not the feeding does.
Practical Terms of the Trial
The regimen begins at a modest volume to limit fluid overload and refeeding risk, with electrolytes checked closely in the first week (Arends et al., 2017). Infusions run overnight, so her days stay free for family and wedding preparations. A home infusion nurse visits weekly, and her husband learns line care before discharge. The four-week review asks four questions: is she at home, is she free of line infection, is her function stable, and does she still want to continue?
What Nutrition Professionals Contribute
The dietitian calculates a regimen that meets needs without overloading fluid, often infusing overnight so Celia is free during the day, and monitors for complications. Just as important, the dietitian helps the team explain what parenteral nutrition can and cannot do: it can prevent starvation, but it cannot stop the cancer or restore her bowel.
Conclusion
Celia should be offered home parenteral nutrition as a time-limited trial tied to her own goals, with a review date and stopping criteria agreed at the start. This honors her choice, follows guidance for carefully selected patients, and takes her oncologist's concerns seriously by building the possibility of stopping into the plan from the first day.
References
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., . . . 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
Druml, C., Ballmer, P. E., Druml, W., Oehmichen, F., Shenkin, A., Singer, P., Soeters, P., Weimann, A., & Bischoff, S. C. (2016). ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clinical Nutrition, 35(3), 545-556. https://doi.org/10.1016/j.clnu.2016.02.006
Naghibi, M., Smith, T. R., & Elia, M. (2015). A systematic review with meta-analysis of survival, quality of life and cost-effectiveness of home parenteral nutrition in patients with inoperable malignant bowel obstruction. Clinical Nutrition, 34(5), 825-837. https://doi.org/10.1016/j.clnu.2014.09.010
The Purdue Global NS490 Unit 8 instructions
In the eighth NS490 unit, students take a position on an ethical question about artificial nutrition and defend it. The prompt usually supplies a case with competing views from the patient, family and clinicians. State your position early and clearly. Name the ethical framework you are using, such as principles or decision standards, and apply it rather than defining it at length. Support each argument with clinical evidence as well as ethics guidance. Give the best case against your view in its most persuasive form, then reply to it. Consider who decides if the patient loses capacity. Practical terms, such as review dates and stopping criteria, show the position can work in real care. Describe the nutrition professional's role. A clear conclusion ties the position back to the patient's goals. Position papers usually run five to seven pages in APA 7.
Inside the NS490 Unit 8 example
The paper opens with Celia's case, her request and her oncologist's concern. Her position is stated in its own short section: offer a time-limited trial with goals, a review date and stopping criteria. The ethical framework treats artificial nutrition as a treatment requiring an indication and consent. Argument 1 applies the cancer guideline's criteria for selected patients, and Argument 2 uses survival data to show her goal is possible. The highlighted sentence states the strongest objection at full strength, and the response explains how the trial answers it. Argument 3 shows that declining feeding is also a decision. A section on lost capacity names her husband as agent. Practical terms describe overnight infusions and a four-week review. The dietitian's role and a conclusion finish the paper.
NS490 Unit 8 rubric: what earns full points
Ethics position papers are marked on the clarity of the stance and the quality of the reasoning behind it. A position stated early and held throughout earns more than a balanced survey that never commits. The framework should be applied to the case, not just described. Each argument needs evidence, both ethical and clinical. Treating the opposing view fairly, and answering it, carries substantial points because it tests the position. Practical safeguards show the stance can be carried out. Attention to capacity and surrogate decisions is often in the rubric. The professional role section shows scope awareness. Clear organization and a conclusion that returns to the patient's goals complete the content. APA 7 references, including an ethics guideline and clinical evidence, finish the grade.
Common NS490 Unit 8 mistakes, and how to avoid them
Many ethics papers describe several viewpoints and never take one, which a position paper cannot do. Others state the opposing argument weakly so it is easy to dismiss. Some writers define principles at length without applying them to the patient. Clinical evidence is often missing, leaving the position resting on opinion. Practical terms like review dates are skipped, so the trial has no shape. Capacity is rarely addressed. The conclusion introduces new arguments instead of closing. When your case involves a contested feeding decision and you are unsure how to argue it, our team can write a position paper on your case with the objection answered fully.
Get an NS490 Unit 8 example written to your instructions
Unit 8 prompts in NS490 differ: some pose feeding in a persistent vegetative state, some a competent patient refusing nutrition, some a religious or cultural objection. Send the scenario, any required framework and the rubric. You receive a stated position, evidence reported at its true strength and the best objection answered fairly, free as a first custom sample, within 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NS490 Unit 8 questions, answered
Do I have to take a side in the ethics paper?
Usually, yes, since a position paper is marked on the clarity of its stance. That does not mean certainty. A position can be firm and still acknowledge where the evidence is thin and what would change your view. Markers tend to reward a defended conclusion with its limits stated over a survey of views that never commits.
Which ethical framework should the paper use?
Whichever your course or prompt names. Principles such as autonomy, beneficence, nonmaleficence and justice are common, and decision standards such as substituted judgment and best interests suit cases with a surrogate. Whatever the framework, apply it to this patient; naming principles without showing how they bear on the case earns little.
Can a dietitian refuse to support a feeding tube?
In a course paper, the more useful question is what the dietitian's role is. That role is to provide accurate information, respect the decision-maker's authority and plan nutrition for whichever route is chosen. A personal objection is handled through professional channels, not by withholding care, and the paper should reflect that distinction.
Where can I find a free NS490 Unit 8 sample paper?
This page offers a complete NS490 Unit 8 ethics position paper supporting a time-limited trial of home parenteral nutrition for a woman with malignant bowel obstruction, with the objection answered.
What stopping criteria does the NS490 Unit 8 sample set?
Recurrent line infection, rapid decline in function, a hospitalization caused by the feeding, or Celia's own request. They are agreed at the start, with reviews at four weeks and before the wedding.