I recently posted the story of Raymond, a helpless demented patient whose loved ones, knowing that he had no quality of life, decided to discontinue oral feedings.
A variation on the theme of nutritional support involves feeding tubes. For patients who cannot ingest calories orally, a feeding tube can be placed. This is a surprisingly easy and a relatively safe procedure involving a small incision in the abdominal wall, a puncture of the stomach, and insertion of a flexible, hollow tube. The tube is secured, and a liquid diet, in caloric amounts sufficient to sustain life, is dripped in. This arrangement can sustain life indefinitely. There is nothing like the original equipment, though, and the tube placement can get infected and/or the patient can suffer pneumonia from the feedings backing up and going into the lungs (i.e., aspiration pneumonia).
These feeding tubes often get placed during an acute illness from which there is legitimate reason to think recovery is possible. The idea would be that the tube could be eventually discontinued and normal eating resumed. Grace was a 83 year old female who had a moderate degree of dementia when she suffered a stroke that left her unable to swallow. In the reasonable hope that she would recover from the stroke, a feeding tube was placed to support her until she was able to eat on her own. Alas, the patient never recovered and her mental status worsened. Cognitively oblivious, she was soon unable to do anything, including swallowing, so the tube feeding was her only source of nutrition.
Again the question of the quality of life arose, and again family members had differing views on withdrawal of nutritional support. Also, for many caretakers, stopping tube feeding seems to be a more active intervention, and therefore more intimidating, than simply stopping oral feeding. After much discussion, and consultation with a religious figure close to the family, the decision to discontinue tube feeding was made. Grace lasted an unusually long time–three and a half weeks, every second of which was agonizing for the family. Like most families, though, they were grateful when Grace’s suffering ended.