Informational Statement for Patients, Family Members, and Friends Regarding Tube Feeding
(Provided with the permission of Durham Regional Hospital)
Introduction
Artificial feeding (nutrition and hydration) can be provided to patients when they cannot eat or drink by natural means. It is commonly provided by “tube feedings.” These feedings are provided by a tube placed into the stomach, either through the nose and down the esophagus (swallowing tube) or directly through the belly wall and into the stomach or intestine.
Although feeding by either of these means might seem “simple” to do, nevertheless, this intervention is considered by medicine and the courts to be equal in intensity to placing a patient on a respirator or kidney machine. It is considered an artificial means of support.
Because this treatment can have such a significant influence on a patient’s quality of life, which has ethical implications, it is important to consider background issues and implications of this particular treatment.
Who makes the decision to provide artificial feeding?
The most appropriate person to make the decision to feed someone is the patient himself. This requires a competent patient who understands what is being done to him, and the long-term risks, benefits, and complications. If the patient is not capable of understanding these things, the next of kin or the durable power of attorney for health care decisions will approve the procedure.
If someone signs for the patient, that person should decide to proceed with the feeding tube based on what he thinks the patient would have wanted if he were able to make the decision. It is important not to choose this treatment based upon what the next of kin or the “power of attorney” wants, but rather on what the patient would want if he were able to state his feelings.
Is there any choice but to feed the patient?
Yes, there is a choice. Artificial feeding does NOT have to be provided to every patient. In making this decision, how the patient is expected to do over time is the most important consideration. Is the patient expected to recover? How long is this recovery expected to take? Will the patient get worse? Is the feeding helping the patient’s quality of life, or is it merely prolonging an “ultimate” death? These are questions that should be asked.
Finally, remember what would the patient want if he was able to say what he wanted?
Once we start the feeding, can it be stopped in the future?
Yes. Any treatment can be stopped once started if it is determined that it is not beneficial to the patient or the patient wants it stopped. In addition, sometimes things change with time, and it might become clear to observers that after time has passed that the patient will not change or improve in spite of the feeding. It would be appropriate to stop under these circumstances. Artificial feeding is no different than any other medical treatment. It is not permanent. It may be stopped.
Does stopping the feeding affect life insurance?
No. If feeding is stopped and the patient dies, it is not considered suicide. The patient has died because of the underlying disease process. Life insurance payments are not affected when medical treatments are stopped, and the patient is permitted to die.
Are dying patients more comfortable with artificial nutrition?
Usually only if the patient requests it. Reports from dying patients indicate that they increasingly experience a lack of appetite and thirst. It is common for competent hospice patients to refuse food and water. Dry mouth is the only reported common symptom, and this can be managed by mouth swabs or ice chips.
Summary
Before beginning artificial tube feeding, it is important to decide whether it will be effective and beneficial to the patient. It is also important to think about what the patient would have wanted to do under the current circumstances. If there is real hope of recovery, and the feeding will help with that process, then it is reasonable to begin artificial feeding. If there is no hope of improvement, or if after time has passed and it becomes clear that feeding is only prolonging an inevitable death, then if the patient or the family agrees, it can be stopped.
It is hoped that this paper will help families through these difficult feeding questions with loved ones. Early, careful examination of these questions may help both patient and family to find a satisfactory level of peace with these difficult problems.
Feeding Tube FAQ
What is tube feeding?
Tube feeding is a liquid food that provides the body with a liquid nutrition formula.
What are the different types of feeding tubes?
Short-term tubes:
- Nasogastric (NG): feeding tube inserted through the nose into the stomach.
- Nasoduodenal (Corpak or dubhoff): tube inserted through the nose into the top of the small intestine called the duodenum.
- Nasojejunal (Corpak or dubhoff): tube inserted through the nose into the second part of the small intestine called the jejunum.
Short or long term tubes:
- Gastrostomy tube (G-tube): a feeding tube placed directly through the skin into the stomach.
- Jejunostomy tube (J-tube): a feeding tube placed through the skin into the stomach or small intestine.
- PEG/PEJ: stands for Percutaneous Endoscopic Gastrostomy/Jejunostomy. Same as above except placed by endoscopic procedure.