Feeding Tubes at the End

¶ … feeding tubes at the end of life. The writer examines literature with regards to patients who have dementia, cancer and other end of life issues and reviews what has been concluded about using feeding tubes at this stage. There were three sources used to complete this paper.

The past few years have seen many controversial stories played out in the news regarding end of life feeding tubes and their use. Society lines up on both sides of the issue and hotly debate whether or not using a feeding tube at the end of one's life is something that should be done even if the patient is not capable of consenting. Meanwhile patients all over the nation languish between the two sides of the debate with their families trying to make the most humane and compassionate decision regarding the placement of a feeding tube into their loved one. Many studies have been conducted regarding the use of a feeding tube on a patient who is at the end of life with differing results. With a small risk in the actual placement of the tube the question centers around whether prolonging life with a feeding tube is really in the best interest of the patient.

LITERATURE REVIEW

One of the more controversial issues surrounding the use of a feeding tube is with patients who have Alzhemier's Disease. Patients with dementia often refuse food and without the ability to communicate it is difficult to determine whether they feel hunger or whether they want the life sustaining measures of a feeding tube used in their care.

According to Doctor Thomas Finucane the use of feeding tubes in patients with the disorder varies from state to state. One study examined the use of feeding tubes for this patient population and found that in Maine only 7.5% of the patients had feeding tubes inserted whereas in Missouri that figure increased to 40%. Further study indicates that the two factors most often present in the decision not to use a feeding tube are (1) the specific request by the patient or the patient's family not to use one, (2) being of white heritage (Finucane, 2001).

In addition the study notes the economic differences in the two states as a possible reason for the differences.

Another study examined the survival rate of patients who had feeding tubes placed against patients who did not. The study included more than 81,000 patients and concluded that the use of a feeding tube provided an average of survival for six additional months as opposed to those who did not have one placed whose survival rate was just over a month.

Using a tube and not using a tube each have their benefits and their problems. The study reported a higher incidence of pneumonia with patients who had feeding tubes inserted, while those who did not have tubes reported a higher incidence of malnutrition.

In increase in pneumonia for patients with feeding tubes and dementia relate to aspiration pneumonia as well as pneumonia caused by infection, however further examination indicates that patients who have difficulty swallowing their food also run the risk of contracting aspiration pneumonia (Finucane, 2001).

While there was not data at the time of this study as to whether tube feeding reduces the rate of infection in the urinary tract and other parts of the body, there was significant evidence that feeding tubes do increase the probability of infections in the ear, esophagus, lungs, abdomen and blood (Finucane, 2001).

The quality of life was another issue addressed in research of the use of feeding tubes with patients who have dementia (Finucane, 2001).

Robert MCCann, MD reports that the everyday imagery of food and its pleasant addition to life cannot be ignored in the discussion of removing natural nutrition and using a feeding tube.

McCann reminds the medical community that the image of a family gathered around the Thanksgiving table, interacting and nurturing each other through the meal presents an entirely different image than an elderly person suffering from dementia alone in a bed in a nursing home with a tube inserted into their stomach. The imagery of food and its measurable impact on a person's life must be accurately envisioned for the decision to be made according to McCann (Finucane, 2001).

McCann studied Hospice cancer patients who were in the end stage of life. According to his research it is a natural part of dying to lose one's appetite as well as one's thirst.

He posits that to interrupt that natural process is actually to place a burden on the patient who is at the end stages of their life. The participants in this study were alert and cognitively responsible in the final days of life and expressed an desire not to have a tube as their desire not to eat was something they did not feel they were suffering because of.

In a study specifically confined to the attitudes of nursing staff members and patient relatives with regard to the use of feeding tube use the participants indicated they were ambivalent to its use and did not report any improvement in the patent's quality of life when a tube was used (Lebovitz, 2001).

An article published by Mary Ersek PhD RN in 2003 addressed the need for further research. According to Ersek the feeding tube controversy has not been laid to rest because the studies do not indicate with conclusive evidence whether or not they have a place in the care of those at the end stages of life (Ersek, 2003).