Navigating Medically Assisted Nutrition in Advanced Dementia through Practical Wisdom and Goals of Care

Abstract

Clinical decisions about medically assisted nutrition require practical wisdom: a goal-directed virtue that makes decision-making purpose-oriented rather than intervention-focused. This deliberative process includes seven basic dimensions: diagnosis, prognosis, test or treatment, burdens, probabilities, goals of care, and clarification of diagnosis or prognosis. These must be integrated within a larger framework of meaning constituted by foundational beliefs and values—for example, social, philosophical, or theological perspectives on human identity, dignity, and purpose—that are substantive enough to explain the clinical context and clear enough to guide a reasoned response to it. This framework, which combines goal-oriented reasoning with empirical data, can clarify the assessment regarding the benefits of percutaneous endoscopic gastrostomy for persons with advanced dementia.