Tube Feeding – Is It Ethical?
Tube feeding—a frightening topic when brought up by a member of your care team. As a dietitian working in the hospital, tube feeding is a part of my everyday work flow. However, for those on the receiving end and the family members involved, one would hope it is not normal and not a part of their everyday life. Tube feeding can be a very scary topic for some people to talk about. Some may even argue that it is not ethical. My hope in this posting is for you to better understand why tube feeding may or may not be considered by the medical care team, when it is and isn’t ethical, and how you can help your loved ones feel at ease.
Different Types of Tube Feeding
“Tube feeding” is a blanket statement – there are actually many different routes/methods for medically assisting someone with nutrition and hydration. The most basic kind of tube is inserted through the nose and settled into the stomach. Some may need the tube advanced into their small intestine. Others may need to have it started in their mouth rather than the nose. Lastly, in those who need constant assistance with nutrition, there are tubes that can be surgically placed directly into the stomach or small intestine and stay there until medically removed.
In special cases when the gut is not able to handle any nutrition or fluids, we might elect to use TPN – also known Total Parenteral Nutrition or intravenous nutrition. However, this is rare because we certainly like to use the gut whenever we can.
When is Tube Feeding Appropriate?
Everyone has a right to basic health care. Food and water, even when medically administered, is ordinary, basic health care (Coleman, 2010). For those who have trouble swallowing (dysphagia/odynophagia), cannot swallow at all, are in a vegetative state, or just cannot get in enough food orally no matter how hard we try (this could be due to many reasons), tube feeding may be the right answer whether that be for a short amount of time or long term.
Keeping in mind that everyone has the right to basic food and water (even if it has to be given through a tube), we do need to consider some other scenarios as this is not even close to a “one size fits all” conversation. However, if you are experiencing any of these problems knowing how to see a registered Dietitian is helpful.
When is it Not Appropriate?
According to Pope John Paul II, “The decision regarding the use of medically assisted nutrition and hydration must be based on the actual medical condition of the patient;” and “an exception can be made if tube feeding is determined to be disproportionate or medically futile, in which case the intervention may be withheld or withdrawn. In all cases, the patient is to remain the subject of care, comfort, and love.”
So what does this mean? It means that sometimes tube feeding becomes excessively burdensome and no longer achieves what we wanted it to: to sustain life comfortably and lovingly. There are some who psychologically cannot deal with the idea of having to be tube fed. There are others where medically assisting with nutrition/hydration really won’t make a difference in their recovery. Or, if someone is dying, we simply need to respect that the body is passing on and nothing else can be done.
Don’t Be Afraid if a Provider or Dietitian Brings up Tube Feeding
If you or your loved one is in the hospital and nutrition/hydration has been a challenge or impossible, your provider or registered dietitian may suggest having medical assistance through a tube feeding, which can be scary for a lot of people to hear. In some cases, it can cause a great deal of shock and grief over how much a disease has potentially progressed. Know that this conversation comes from a place of love, a desire for the patient to be comfortable, and is born of medical concern that recovery is being inhibited because the building blocks of nutrition are not in place for meaningful healing. Your dietitians and providers want to set up those who are on the road to recovery for success. In some cases, this means medically assisted nutrition and hydration.
We also understand this is a big decision to make and one that is not easy. We want to listen, we at CHI Health’s Nutrition Services are here to answer your questions. We understand if you just don’t want to do it. No matter what you decide we are here to care for you and your loved ones.
Coleman, G. D. (2010). What’s extraordinary?: Catholic wisdom on end-of-life care. Retrieved from https://www.americamagazine.org/issue/746/article/whats-extraordinary
These blogs are written by members of the CHI Health Nutrition Services team.