Is Tube-feeding Always Appropriate?
Rarely are there black and white answers about whether using tube-feeding is appropriate. The decision depends on many factors such as the patient’s basic health, chances of recovery, will to live, and the burdens and benefits of further treatment.
You can talk with your health care team if you are unsure about the appropriateness of using tube-feeding. They can give you information to help guide your decision.
As you think about tube-feeding, your head as well as your heart will help you decide.
This information is a “starting place” for conversations among patients, families, and caregivers. It can prepare you for talking with health care professionals when a patient has very serious medical problems. Keep in mind that the best time to discuss these issues is before a crisis occurs.
Many People Ask. . .
* “How does tube-feeding work?”
* “What are its benefits and burdens?”
* “Is tube-feeding always appropriate?”
* “What if I don’t want tube-feeding?”
Where Do You Turn For Answers?
Facing decisions about tube-feeding can be terribly difficult. Often, it is a time of emotional confusion and suffering for families and caregivers, as well as for patients.
Your health care team can help you learn more about the benefits and burdens of tube-feeding.
What Are Some Benefits Of Tube-feeding?
Short-term tube-feeding may help a patient survive and regain the ability to eat and drink naturally. During recovery from an operation, an accident, or serious illness, tube-feeding can maintain life. It can also build up a patient’s strength before surgery.
What Are Some Burdens Of Tube-feeding?
Feeding tubes can have serious risks. They can cause pneumonia, infection, and discomfort, and in some conditions they do not make a difference in the patient’s survival. Patients who try to remove the tubes may injure themselves, or they may have to be restrained, chemically or physically. Many terminally ill patients who voluntarily abstain from using tube-feeding report having more comfort, and less pain, than patients on tube-feeding do.
What Happens If Tube-feeding Isn’t Used?
A lot depends on the patient’s condition. In a study of 1,386 nursing home residents, age 65+ with advanced dementia, there was no difference in survival with or without tube-feeding. Many patients with advanced illness, such as Alzheimer’s Disease or cancer, do not feel hunger or thirst. Their appetites naturally fade as death approaches. Unless the patient regains the capacity to eat, death will naturally occur.
As You Think About Tube-feeding. . .
The following summaries are taken from medical journals. We encourage you to discuss these statements, and other viewpoints as well, with your health care providers.
“For patients with a good prognosis of recovery, tube-feeding should be provided.”
Source: Hodges M, Clin Geriatric Med 1994; 10:475-88.
“Each case is unique and should be handled differently. . .Potential benefits versus burdens of tube-feeding or parenteral feeding should be weighed on the basis of specific facts concerning the patient’s medical or mental status. . .”
Source: Am Dietetic Assoc, J Am Dietetic Assoc 1992; 92:996-1002.
“Taken in total the reports, laboratory studies, and observations of nurses and physicians who care for terminally ill patients suggest that lack of food and water does not cause suffering and may even leave terminally ill patients more comfortable.”
Source: Bernat J, Arch Intern Med 1993; 153:2723.
“Symptoms of dehydration were completely relieved with ice chips, sips of liquid, lip moisteners, hard candy, and mouth care. Lack of fluids produced positive effects of less choking and less need for suctioning.”
Source: McCann R, JAMA 1994; 272:1263.
“In caring for terminally ill or chronically ill patients, tube feedings are often initiated to alleviate the anxiety of caregivers and families of patients. . .Families need to know that loss of a normal appetite is commonly observed in dying patients and does not contribute to their suffering.”
Source: McCann R, JAMA 1994; 272:1263.
Important Words of Caution
Short-term “trial periods” of tube-feeding can sometimes show whether longer periods will lead to recovery, or just prolong the patient’s dying.
As You Think About Tube-feeding. . .
You can take comfort in knowing you are not alone. Other people have had to make these important decisions. It may help you to keep these questions in mind:
* “What are our goals for medical treatment?”
* “How often should we re-evaluate using tube-feeding?”
* “What would my loved one choose?”
Resources You Can Use
National Hospice Organization
(800) 658-8898 or (703) 243-5900
web site address: www.nho.org
Promotes quality comfort care, pain relief, and emotional and spiritual support for dying patients and their families.
Ethics Committees
Ethics Committees are available at hospitals and nursing homes to help patients and families communicate with hospital staff and try to resolve disagreements. The administration or chaplain’s office at the health care facility where the patient is admitted should be able to provide information on how to contact the ethics committee.
Alzheimer’s Association, Honolulu Chapter
(808) 591-2771
web site address: www.alz.org
Provides information, education, and support to patients and families about Alzheimer’s Disease and related dementias.
*Information on this page was created by and obtained with permission from the Colorado Collective for Medical Decisions, Inc. (CCMD), 1999, and Hospital Shared Services of Colorado.