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Is
Tube-feeding Always Appropriate?
Many People Ask. . .
Where Do You Turn For Answers?
What Are Some Benefits Of Tube-feeding?
What Are Some Burdens Of Tube-feeding?
What Happens If Tube-feeding Isn't
Used?
As You Think About Tube-feeding.
. .
Resources You Can Use
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.
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