Tube feeding: Prolonging life or death in vulnerable populations?

Abstract

Tube feeding can be an appropriate and effective means of providing nutrition for individuals who are unable to achieve adequate nourishment orally because of various medical problems. However, the delivery of nutrients by tube feeding can cause ethical dilemmas in cases where the effectiveness of tube feeding diminishes and medical complications increase. The decision to tube feed is often influenced by regional and cultural preferences, as well as the high cost of providing mealtime assistance. The effectiveness and appropriateness of tube feeding has been the subject of much debate as it applies to those with severe cognitive impairments and those who are in a persistent vegetative state (PVS). Recent research shows that in these vulnerable populations, tube feeding alone does not necessarily prevent malnutrition and risk of infection or improve functional status and comfort. While advanced directives allow an individual to make decisions about his or her care at the end of life, court cases and religious doctrine examine the individual's right to autonomous decision making in opposition to preserving the sanctity of life. As long as the outcome of this debate is largely undecided, the process of dying may be prolonged for those who can no longer advocate for themselves.

Challenges for professional care of advanced dementia

“…The lack of clarity about the goals of care imposed ethical dilemmas that might bring well‐meaning clinicians into conflict with the law, community expectations, institutional policies, the person's family and what the person might have wished. A conspicuous example is that of tube feeding, whereby prolonging life could be perceived as prolonging death 23 …”

“…A conspicuous example is that of tube feeding, whereby prolonging life could be perceived as prolonging death. 23 For the health professional there might be no single correct response to terminal illness, only a range of choices. 24 Advance care directives expressing an individual's prospective care preferences would assist in negotiating with family members.…”