Articles > Ethics > Tube feeding and hydration...

Tube feeding and hydration...

Published by Chapster on 2005/3/17 (9214 reads)
The following paragraphs offer two things. First, we will provide links that both laypersons and professionals can refer to to gain greater understanding about tube feeding (and, to some degree, hydration). Second, we have seen both benefits and costs to tube feeding. We offer in the latter half of this section some perspective that we have gleaned in the years we have been doing end-of-life care.

Links to Journals and Information on Other Sites

Here, we have tried to gather some links to help laypersons and professionals have resources to draw on when considering the use of a feeding tube. And, here are the links:

Georgia Gastroenterology Group, PC

Journal of the American Medical Association

FindArticles.com

TheRubins.com

TheRubins.com

The Star Tribune

Archives of the Journal of Internal Medicine

Hospice of Dayton

The Neurology Channel

American Medical Directors Association

The Alzheimers Association

TheGardenWeb.com

The list could go on and on.

Some additional thoughts

We would encourage visitors to avoid the rhetoric that flies around discussions about tube feeding and hydration. It is seldom accurate. For instance, it is commonly said that when someone removes a feeding tube they are starving the person to death. That may or may not be true. To starve to death presumes that the body is ready, willing, and able to process food and liquid on its own. Such may not be the case. Many times, the body, if not force fed would stop taking and processing food. Think of it this way: whenever you hear the words they're starving him/her to death remember to think that the other folks are arguing for force feeding them, often against the sensibilities of the body. To forgo tube feeding when a person is dying allows nature to take its course.

In terms of understanding what you need to know about tube feeding, here's some considerations. As the body prepares to die, it naturally is less able to process food and hydration. Here's the reason: The process of converting food into energy stores, which is what we do when we are well, takes enormous amounts of energy in itself. If we are well, the body easily converts eaten food into energy for the tasks that we do on a day to day basis. But, as we get closer to death our bodies naturally ingest less food or none at all.

Especially as we get near the very end, the focus of the body is on two things: breathing and circulation. So, guess what happens whe we add the demands of food processing and energy conversion at this time? That's right! The body can't handle it. It can't process the food, because it doesn't have the energy to do so. So all that well-intended sustenance gets shoved off into the extremities in the form of swelling (edema) and eventually it goes to the lungs. When it enters the lungs it increases the risk if aspiration (choking, drowning).

One of the marvels of caring for the dying for the last 20 years is that I become more and more convinced of the wsdom of our Maker. In the dying process, it seems like it is meant for our ability to intake food and fluid to decline because that is Nature's way of preparing us for less suffering. The suffering of edema seems much worse and more painful than the gradual decline of someone who does not have fluid overload, a characteristic of those who are tube fed and hydrated until death. Moreover, it seems that those who are not fed in this way are often able to enjoy life further into the dying process than those who are coping with the dual demands of stasis and food processing. It's just too much for the body.

Here's a final thought:

"There is tremendous debate in our nation over euthanasia, and it will only grow as the numbers of elderly increase. As those who work with the elderly, we are staunchly against the practice of euthanasia. However, we are also deeply troubled by the view that death is something to fix. With the Industrial Age, we began to feel we could fix everything, including death. We can't and we shouldn't. Death is as natural as life.

We have seen many people being kept alive, if one can call it life, with endless doses of antibiotics, feeding tubes, amputations, resuscitations, and repeated surgeries. Often they are not able to interact well (if at all), enjoy life, or participate in life in any meaningful fashion. They are the equivalent of human stick figures. Unless they have indicated they wanted all available means used to save them, this is wrong.

In our experience, if euthanasia is immoral, then so is the nonstop merry-go-round of prolonging life that is occurring in our medical institutions. To our sensibilities, it is hypocritical to pontificate on the sanctity of life, all the while ignoring the plight of those forced to stay alive when their bodies, in and of themselves (apart from non-natural interventions), have no ability to sustain life. If God wants to perform a miracle of healing, it can be done just as easily without the medical equipment as with it.

Again, to be clear. ElderHope, LLC does not believe in the practice of euthanasia (we do not see Double Effect as a form of euthanasia). Where a patient has indicated of his/her own volition a willingness to persevere in treatment, we support that treatment. We do believe, however, that patients should be treated as human beings who are facing a part of life that is as significant, sacred, and meaningful as birth. To use people as experiments in life prolongation or because we can't come to grips with our own grief process is as morally troubling as euthanasia has ever been.

Oh well, the soapbox is now cleared..."

Tags: feeding   TPN   artificial   hydration   tube  

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