KEOM & ElderHope : Advance Care Planning: Tube Feeding
Posted by Chapster on May-31-2003 (4677 reads)

Is tube feeding the kind of subject that needs to be covered in your Durable Power of Attorney for Health Care or your Living Will (now known as the Directive to Physicians)? Absolutely. Find out why in this latest script from one of this month's Community Focus segments at KEOM, 88.5FM. In this discussion with Dr. James Griffin, station manager at KEOM, we talk about the importance of clarifying your wishes about artificial feeding...

Advance Care Planning: Tube Feeding
KEOM & ElderHope
Taped in the KEOM studios on May27, 2003

Q: So, Mike, last month we began talking about how we should write down and discuss what we would want if we were terminally ill or not able to communicate our wishes. Specifically, you mentioned CPR, the process of manually trying to restart the heart. What are we talking about today?

A: Today, I thought we would talk specifically about artificial feeding and advance directives. Many of us may face a disease that will leave us with the possible need for artificial feeding through a tube. And, it is an option that we have to use this approach or to simply monitor ourselves for pain and discomfort and be allowed to die naturally.

Q: I suppose the question that a lot of people have is this: Is this similar to euthanasia?

A: No. It’s not. It is the process by which we have let elders and loved ones go for millennia. Euthanasia by most definitions is the active and intentional termination of a life.

Q: Well, is this a process of starvation?

A: That’s a good question and the answer is, No. In general, the situation that we are talking about today is one where the cognitive processes of an individual are so diminished that they are almost non-existent. They are not able to be part of the world around them, mentally. They are not able to enjoy interaction with others. And, they are often not even able to process food by chewing, due to loss of swallow function. The research that is available indicates that there is no discomfort with discontinuing or not using tube feeding, as long as good mouth care is made available and the mouth is kept moist. Hunger sensations are not typically part of the end-of-life scenario. For those folks who are awake and alert, they are able to choose the method of care that they want, and their choice should always be honored. For them, pleasure feeding is an option. This is where tiny amounts of food are given, purely to enjoy the taste. The patient, with help, then disposes the food. The point is that starvation occurs where there is hunger. For those who are dying, there is no sensation of hunger. Again, however, we are not talking about robbing someone of food, where their body is able to use it to restore itself to health.

Q: Do you oppose tube feeding?

A: No. If the patient wants it, then that is all that is important. Also, if it is restorative, that is, if they can use it to get better, then it is a very good tool.

Q: What are the risks of tube feeding?

A: Some of the risks, among others are increased susceptibility for aspiration - choking - and aspiration pneumonia, increased swelling, and fluid overload. They are quite serious and can lead to profound suffering, especially if the feeding is not closely and carefully managed. Here’s an important concept: As the body declines and enters the dying process, it is focused solely on the next breath and the next heartbeat. It is not focused on digestion. Indeed, our digestive process uses up so much energy that the body tries to set aside the digestive processes during the end-of-life, in order just to maintain the breathing/heartbeat functions. The body can’t do all that it is being asked to do when it is being force-fed. So, the fluids from the tube feeding tend to swell the extremities and then fill up the lungs making it even harder to breath.

Q: So, this is something that our listeners should consider in their Advance Directives?

A: Absolutely. While well-intentioned, medical personnel will generally always err on the side of preserving life regardless of what the quality of that life will be. And, in our experience, it is always much harder, emotionally, to stop tube-feeding, once it is begun, than to forgo it before it is started. By defining for our loved ones how we would want to be treated in these situations, we can spare them great emotional suffering.

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