Food, Feelings and End of Life Wishes

The New York Times has a recent article about Food and the Dying Patient. It talks about a patient with dementia who could no longer swallow. When they tried to feed her she aspirated the food into her lungs which was causing pneumonia. The doctors turned to the family to decide whether they wanted a feeding tube surgically put into the patient’s stomach to deliver nutrition.  In this case, the family felt as though not putting the feeding tube in was cruel, because she would be hungry.

The next day, my patient was wheeled down to the operating room for her feeding tube, then a few hours later wheeled back to intensive care. Over the next couple of weeks, her sister sat on a chair beside her most days, wearing the requisite paper gown and gloves for guests of patients with resistant bacteria from prolonged hospital stays. She sat off to the side, separated from her sister by tubes, bedrails and the bustle of activity around them.

The patients family thought they were doing the kind thing, but as the physician points out:

But contrary to popular belief, a feeding tube does not prolong life in a patient with dementia. It actually increases suffering. A stomach full of mechanically pumped artificial calories puts pressure on an already fragile digestive system, increasing the chance of pushing stomach contents up into the lungs. And surgically implanted tubes are a setup for complications: dislodgments, bleeding and infections that can result in pain, hospital admissions and the use of arm restraints in already confused patients. But maybe most important, the medicalization of food deprives the dying of some of the last remnants of the human experience: taste, smell, touch and connection to loved ones.

Prior to reading this article, I hadn’t thought about the possible down sides of feeding tubes for patients in this type of situation, where they would need the feeding tube until they died. (There are some cases, such as a person receiving radiation for cancer of the mouth or neck where short term feeding tubes are necessary and helpful.)

The thing I took away from it was that educating yourself on what the pros and cons of various procedures are at different point in an illness is vital. Thinking about scenarios ahead of time so that you can communicate your wishes to your family, and understanding the pros and cons if you are the person faced with making the decision are crucial steps in the process. Someone who may want a feeding tube for a short period of time to restore health, may not want one if it will simply delay death and possibly cause further complications or confusions in the patient.  The more information you and your family have about your condition and the suggested treatments the easier it will be to make decisions that are in line with your wishes.

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