Vienna Declaration on the Human Right to Nutritional Care

Adopted on 5 September 2022 at the 44th ESPEN Congress in Vienna. Signed at the corporate level by the four continental clinical-nutrition societies (ASPEN for North America, ESPEN for Europe, FELANPE for Latin America, PENSA for Asia), by EFAD (European Federation of the Associations of Dietitians), by EPF (European Patients’ Forum) and by more than seventy national societies. Endorsed at the inaugural session by Stefan Schreck (DG SANTE, European Commission) and Kremlin Wickramasinghe (WHO Europe).

The full text is available as a five-page PDF from ESPEN and as an eight-page annotated version from DGEM. Formal publication followed in Clinical Nutrition (Cárdenas et al., 2023, DOI 10.1016/j.clnu.2023.04.009) and in Nutrition in Clinical Practice (Cárdenas et al., 2023, DOI 10.1002/ncp.11004).

The text is non-binding. Its normative weight rests on the coordinated adoption by all four continental societies and by the national bodies that answer to them, and on the fact that its central formulation (“nutritional care as a human right intrinsically linked to the right to food and the right to health”) had already been the object of an eleven-year internal argument within the clinical-nutrition field, from Cancún 2008 through Cartagena 2019 to Vienna 2022.

What the text says

The Declaration is composed of a two-part preamble, an Article 1 defining scope, an Article 2 stating aims, and an Article 3 setting out five principles across twenty-one sub-clauses.

The central operative formulation, Article 1:

The Declaration recognizes that access to nutritional care is a human right intrinsically linked to the right to food and the right to health. It sets out a shared vision and principles for implementation of the human right to nutritional care in all patients with disease-related malnutrition, in all settings and conditions.

On the extension of the right to food into the clinical setting, from the preamble:

The human right to food must be respected in all spheres, including the clinical setting and the sick person must be fed in conditions of dignity and has the fundamental right to be free from hunger.

On the ethical duty of the health-care professional (Principle 3.3.2):

Health care professionals have the ethical duty to assure optimal and timely nutritional care within the boundaries of resources provided for them.

On the framework of human-rights principles brought into clinical nutrition (Principle 3.3.5), the Declaration adopts the FREDA principles used in UK mental health law and imports them wholesale:

The Human rights’ FREDA principles (Fairness, Respect, Equality, Dignity, and Autonomy) are central to clinical nutrition practice.

The five principles that structure Article 3, in their own words:

1. Public health policy must make the fulfillment of the right to nutritional care a fundamental axis in the fight against disease-related malnutrition.
2. Clinical nutrition education and research is a fundamental axis of the respect and the fulfillment of the right to nutritional care.
3. Ethical principles and values in clinical nutrition including justice and equity in nutritional care access are the basis for the right to nutritional care.
4. Nutritional care requires an institutional culture that follows ethical principles and values and an interdisciplinary approach.
5. Patient empowerment is a key enabler to necessary action to optimize nutritional care.

The chain that led to the text

The Vienna Declaration is not a fresh formulation. It is the international consolidation of a formula first articulated at the Cartagena Declaration of FELANPE in 2019, itself the culmination of an argument begun at Cancún in 2008. The chain, dated:

• 1948 — Universal Declaration of Human Rights, Article 25 (standard of living adequate for health, including food).
• 1966 — International Covenant on Economic, Social and Cultural Rights, Articles 11 (adequate food, freedom from hunger) and 12 (highest attainable standard of health).
• 2000 — CESCR General Comment 14 on Article 12, which states that the right to health encompasses food and nutrition.
• 2003 — Council of Europe Resolution ResAP(2003)3 on food and nutritional care in hospitals, adopted by the Committee of Ministers on 12 November 2003. The first European instrument to state that access to safe and varied food is a fundamental human right and to recommend national hospital-nutrition standards. Cornerstone European precedent.
• 2005 — UNESCO Universal Declaration on Bioethics and Human Rights, Article 14. Philosophical anchor cited by Cárdenas in later work.
• 2008 — Cancún Declaration (FELANPE). First appearance of the phrase “the human right of patients to receive opportune and optimal nutritional therapy”. De la Cruz Castillo Pineda et al., Nutr Hosp 2008;23(5):413-417.
• 2009 — Prague Declaration (ESPEN + European Nutrition for Health Alliance, adopted 11 June 2009 under the Czech EU presidency). Slogan “Stop disease-related malnutrition”. Public-health framing, no human-rights vocabulary.
• 2019 — Cartagena Declaration (FELANPE, 3 May 2019, coordinated by Diana Cárdenas). The exact formulation “nutritional care as a human right, inseparable from the right to food and the right to health” appears here for the first time, in thirteen structured principles. Published in Revista de Nutrición Clínica y Metabolismo 2019;2(Sup.):14-23. It is this Latin American text that Vienna 2022 will translate to the intercontinental level.
• 2020 — Creation of the International Working Group for Patients’ Right to Nutritional Care, bringing together ASPEN, ESPEN, FELANPE and PENSA under Cárdenas’s coordination.
• 2021 — Foundational position paper: Cárdenas D., Correia M.I.T.D., Ochoa J.B., Hardy G. et al., “Clinical nutrition and human rights. An international position paper”, Clinical Nutrition 2021;40(6):4029-4036, DOI 10.1016/j.clnu.2021.02.039. Co-published in Nutrition in Clinical Practice 2021;36(3):534-544. Sixteen co-authors. Deploys the full theory: nutritional care at the intersection of the right to food and the right to health, the human-rights-based approach, the “respect / protect / fulfil” tripartite, tables for foundations, duty-bearers and content. The Vienna Declaration is its declaratory translation.
• January 2022 — Cárdenas D. et al., “Nutritional care is a human right: translating principles to clinical practice”, Nutrition in Clinical Practice 2022, DOI 10.1002/ncp.10852.
• 5 September 2022 — Signature at the ESPEN Vienna Congress.
• April and June 2023 — Formal publication of the Declaration in Clinical Nutrition and Nutrition in Clinical Practice.
• 12 October 2023 — Compromiso de Asunción adopted by FELANPE, invoking Cancún, Cartagena and Vienna as its normative frame, with six operational commitments based on data from 132 hospitals in 14 countries. Ferreira Heyn et al., Nutrición Hospitalaria 2024;41(1):249-254.
• 9 September 2024 — ESPEN Milan panel on implementation in resource-limited settings, 33 experts from an online survey of 58 respondents in low- and middle-income countries.
• 30 May 2025 — Cárdenas D. et al., “Tackling disease-related malnutrition in resource-limited settings”, Nutrition in Clinical Practice 40(4):762-769, DOI 10.1002/ncp.11310. Ten consensus statements, three-step access strategy, twenty-four working-group members named, Médecins Sans Frontières listed as institutional affiliation.
• 1 May 2026 — Publication of the ESPEN Practical Guideline on Ethical Aspects of Medical Nutrition Therapy (Cárdenas first author, Christiane Druml last author), Clinical Nutrition, DOI 10.1016/j.clnu.2026.106622. First time the human-right-to-nutritional-care formulation enters an ESPEN prescriptive guideline rather than a declaratory text.

Diana Cárdenas as the intellectual architect

The Declaration has an author. Its argument, its formulations and its dating all trace back to one figure. She warrants a fiche of her own and will get one; the sketch here is minimal.

Diana Cárdenas holds an MD from Universidad El Bosque in Bogotá, a Master in metabolism and nutrition from Paris-Diderot, a Master in political science and international relations from Lyon, and a PhD in philosophy from the Université de Franche-Comté. She is currently in the Nutrition Unit at the Institut Gustave Roussy in Villejuif and a professor at Universidad El Bosque. She was previously responsible for the bioethics programme at the UNESCO regional office for Central America. She is Editor-in-Chief of the Revista de Nutrición Clínica y Metabolismo and Associate Editor of Clinical Nutrition ESPEN. She has coordinated the International Working Group for Patients’ Right to Nutritional Care since its creation in 2020.

She is, in 2026, the only figure in the clinical-nutrition field who combines a medical qualification, formal training in philosophy, direct experience of UNESCO bioethics and institutional leadership of the international nutritional-rights programme. She is the point of first contact for any productive engagement between the physiological-rights argument developed here and the clinical-nutrition apparatus.

The working group

The Declaration was drafted, according to the Nutrition in Clinical Practice 2023 article, by:

• Diana Cárdenas (working-group coordinator, Universidad El Bosque and Gustave Roussy).
• Maria Isabel T. D. Correia (Universidade Federal de Minas Gerais; FELANPE ex-president 2015-2016).
• Gil Hardy (Emeritus Professor, Massey University Auckland; Ipanema Research Trust; ASPEN board 2020-2022; ASPEN Nutrition Champion 2025).
• Leah Gramlich (University of Alberta; provincial medical advisor for nutrition services, Alberta; founding president Canadian Nutrition Society).
• Tommy Cederholm (Uppsala University and Karolinska; key author of the GLIM criteria for malnutrition diagnosis).
• Rocco Barazzoni (University of Trieste; ESPEN chair 2018-2024, signatory in that capacity).
• Annemieke van Ginkel-Res (Honorary President EFAD; deceased 25 November 2025).
• Wineke Remijnse (EFAD, Naarden, Netherlands).
• Albert Barrocas (Tulane School of Medicine, New Orleans).
• Juan B. Ochoa Gautier (Hunterdon Medical Center, New Jersey).
• Olle Ljungqvist (Örebro University; historically associated with the Prague Declaration 2009).
• Winai Ungpinitpong (Surin Hospital, Thailand; PENSA representation).

Two names should be added on the trajectory towards the 2026 ESPEN Practical Guideline: Christiane Druml (chair of the Austrian Bioethics Commission and director of the Josephinum in Vienna; last author of the 2016 ESPEN ethical guideline that the 2026 text updates), and Rosa Burgos (Vall d’Hebron, Barcelona; second author of the 2026 guideline).

Where the text still stops, and what is missing

The Declaration’s scope, as stated in Article 1, is limited to patients with disease-related malnutrition, in all settings and conditions. Its normative object is the hospitalized or institutionalized undernourished patient. It has produced, in its follow-on documents, a coherent programme on nutritional screening, on institutional audit, on discharge planning and on ethical practice in artificial nutrition and hydration.

It does not, however, extend to what the physiological-rights argument makes central: the specificity of individual micronutrient adequacy in ostensibly well-fed populations, the failure of serum tests to detect tissue depletion, the twenty-year latency between the science on the physiological requirement of magnesium, of folate, of vitamin D, and its reflection in public guidance. The Declaration is a document on disease-related malnutrition. It is not yet a document on the physiological rights of the whole population.

Two silences deserve note.

First, the Declaration is not cited by the UN Special Rapporteurs on the right to health or the right to food. Tlaleng Mofokeng’s A/78/185 report on food, nutrition and the right to health, the closest UN text to the subject, does not cite Vienna, Cárdenas, Cartagena or the ESPEN 2021 position paper. Michael Fakhri’s reports as Special Rapporteur on the right to food do not cite them either. The clinical-nutrition-rights argument and the UN right-to-food apparatus have proceeded in parallel and have not yet met.

Second, the Declaration is not cited by the leading legal scholars on the right to health or on food law. It is absent from the corpus of Alicia Ely Yamin, of Lawrence Gostin, of Katharina Ó Cathaoir and of the second-circle European legal scholarship on the normative content of the right to adequate food. The clinical-nutrition-rights argument has, so far, remained internal to the clinical-nutrition field.

Why this matters here

Three points.

First, on the precedent. The Declaration is the single largest institutional consensus ever assembled around a human right specific to nutrition in the clinical setting. Four continental societies, more than seventy national societies, a European Commission endorsement, a WHO Europe endorsement, a fully articulated argument from Cancún 2008 through Cartagena 2019 to Vienna 2022, and a genealogy that traces through General Comment 14 and Council of Europe Resolution ResAP(2003)3 back to Article 12 of the ICESCR. The physiological-rights argument developed in this resource has a precedent that it did not have to invent.

Second, on the limit. The Declaration operationalizes the right to nutritional care for the hospital and the disease-related malnutrition case. The physiological-rights argument developed here proposes to operationalize the same underlying right for the population at large and for the specificity of individual micronutrient adequacy. The two arguments are of the same normative shape and use compatible language; the physiological-rights argument extends the Vienna framework by one order of scope, from the sick patient in an institution to the physiological subject in the general population.

Third, on the bridge that does not yet exist. Neither Mofokeng nor Fakhri nor Yamin nor Ó Cathaoir cite the Vienna Declaration. The clinical-nutrition-rights community and the international-human-rights-law community occupy adjacent, non-overlapping literatures. To make that bridge is one of the specific tasks that this resource takes on: to route the Vienna argument into the UN Special Procedures apparatus, into the CESCR General Comment machinery, and into the second-circle legal scholarship, and to route the international-human-rights-law apparatus into the clinical-nutrition societies. Cárdenas at Gustave Roussy and Druml at the Josephinum in Vienna are the two individuals through whom that bridge can be built.