UTMB Research: Artificial nutrition not best

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UTMB Research: Artificial nutrition not best

by University of Texas Medical Branch/ Special to The Daily News

khou.com

Posted on March 16, 2011 at 8:59 AM

GALVESTON, Texas — In a new study looking at people with terminal illnesses,

including dementia, researchers at the University of Texas Medical Branch said

the medical profession might have swung the pendulum too far in its efforts to

keep patients alive.

End-of-life medical care often leads to that conflicting intersection of

personal, medical, legal and policy issues that frequently spill over into the

public arena. The medical profession, in concert with other interests, should

focus more on what is best for a patient — prolonging a life might not be the

most compassionate medical course of action, medical branch researchers

reported.

Looking at ethical concerns, case studies, legal and medical discourse spanning

60 years, researchers said it might be time to reconsider artificial nutrition

and hydration for end-of-life patients.

" We seem to have forgotten the difference between people who died because they

stop taking in food and water and people who stop taking in food and water

because of the natural dying process, " Dr. Brody, lead author of the

study and director of the Institute of Medical Humanities at the medical branch,

said. " There seems to be a growing disconnect between popular ethical

conceptions and the palliative care medical community. "

There is a presumption, Brody said, by many in society, that the only way to

show a patient compassion is to provide nutrition via a feeding tube.

Conversely, palliative care medical professionals have said for decades that

feeding tubes often make patients more uncomfortable at the end of life, and

distressing symptoms can best be managed without them, Brody said.

Many factors influence decisions about tube feeding, including denial by a

patient’s family that a loved one is dying. Other decision points include

compassionate medical care, religious beliefs, legal findings and physician

liability.

The medical branch authors reviewed the complex history of ethical thinking

about tube feeding during the past 60 years. They traced legal, ethical,

religious, medical and policy forces that caused physicians and patients to urge

tube feedings during some periods and to be more skeptical about them in others.

" If you don’t know that history, it’s less likely you’ll truly understand

today’s ethical and policy issues, " Brody said.

As recently as the 1990s, the prevailing medical view was that tube feeding was

effective in extending a patient’s life. But data began to emerge during that

time that tube feeding for terminally ill patients, especially those with

advanced dementia, was futile. In fact, data showed no improvement in quality of

life and often led to complications such as pneumonia, nausea and diarrhea, the

medical branch researchers said.

Palliative medicine rarely involves tube feeding, recognizing that as a patient

approaches end of life, bodily functions slow accordingly. And many terminally

ill patients develop a loss of appetite and thirst that is complicated by

difficulty in swallowing, paralleling a body’s inability to absorb nutrients.

" So today we think that the palliative care perspective is really the best one, "

Brody said. " We think that it is ethically sound but that many practices and

policies and public misconceptions get in the way of taking that approach. "