Academic journal article The Hastings Center Report

The Facts about Tube Feeding: What Benefit?

Academic journal article The Hastings Center Report

The Facts about Tube Feeding: What Benefit?

Article excerpt

On the theme that more evidence could make for better ethics: Thomas Finucane and colleagues argue in the 13 October 1999 issue of JAMA that the argument for providing artificial nutrition to patients with advanced dementia rests on premises never proven true ("Tube Feeding in Patients with Advanced Dementia: A Review of the Evidence," pp. 1365-70). If true, then the ethical discussion about tube feeding such patients has failed to engage the real world.

As the authors note, the argument for tube feeding severely demented patients has chiefly been that it would prevent aspiration pneumonia and forestall malnutrition and so perhaps postpone death. Tube feeding is also supposed to provide comfort by keeping patients fed. Yet the authors found no direct evidence that tube feeding achieves any of these outcomes for severely demented patients. There are no randomized clinical trials comparing tube feeding with oral feeding for this group and what data are available suggest that tube feeding is in general useless: it is apparently not associated with better outcomes with respect to aspiration pneumonia, nutritional status, pressure sores, infection, comfort, or survival, and it is associated with a wide range of complications and other burdens on the patient, ranging from the necrosis of tissue in contact with the tube to the use of restraints to prevent the patient from pulling the tube out. …

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