Tube-feeding decisions in the elderly

M. O. Hodges, Susan Tolle

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Tube-feeding decisions in the elderly can be most challenging. We begin our decision making with the premise that artificial nutrition is a medical therapy and therefore that its prescription is based on a calculation of net benefits over burdens for the patient to whom it is given. When the burdens of this therapy outweigh the benefits of prolonged life, tube feeding may be ethically withheld or withdrawn. For the cognitively impaired and in the absence of known patient preferences, the ratio of benefits to burdens may best be figured after a time trial of therapy. If restraints are needed to keep the tube in place, or if significant medical complications ensue, the burdens of the therapy have outweighed its potential benefits, and the therapy may be ethically withdrawn. State statutes and institutional policies are often confusing and at times in conflict with the ethical choice made by families and health care providers for their loved ones and patients. The options-starting a court battle (Cruzan7), moving the patient to a different state (Busalacchi), or committing civil disobedience-are not best for the welfare of the patient, family, or health care team. We well recognize that what is legal is not always what is ethical. Ethics should lead the law as we consider how to use new health care technologies wisely. We hope that the state legislatures will work to minimize future conflicts by acknowledging that (1) artificial nutrition is a life-sustaining therapy that should not have special status distinct from other life-sustaining therapies and (2) artificial nutrition and hydration are medical therapies that can and should be ethically withdrawn or withheld when their burdens outweigh their benefits.

Original languageEnglish (US)
Pages (from-to)475-488
Number of pages14
JournalClinics in Geriatric Medicine
Volume10
Issue number3
StatePublished - 1994
Externally publishedYes

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Enteral Nutrition
Patient Care Team
Family Health
Therapeutics
Organizational Policy
Nutrition Therapy
Moving and Lifting Patients
Biomedical Technology
Patient Preference
Ethics
Health Personnel
Prescriptions
Decision Making

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Tube-feeding decisions in the elderly. / Hodges, M. O.; Tolle, Susan.

In: Clinics in Geriatric Medicine, Vol. 10, No. 3, 1994, p. 475-488.

Research output: Contribution to journalArticle

Hodges, M. O. ; Tolle, Susan. / Tube-feeding decisions in the elderly. In: Clinics in Geriatric Medicine. 1994 ; Vol. 10, No. 3. pp. 475-488.
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