Removing Feeding Tubes

The decision to place a feeding tube carries medical, ethical and legal implications to the medical profession, patients and their families. Because of the circumstances under which feeding tubes are placed, patients often have no say other than legal documents and family members' knowledge of their wishes. The same holds true for the removal of feeding tubes. Everyone involved has to be aware of what the patient wants in order to make the right decision.

Medical Issues

• Tube feeding, or percutaneous endoscopic gastrostomy (PEG), is a deceptively simple procedure performed by doctors on their patients when they are unable or unwilling to eat. It is a deceptively simple procedure because PEG doesn't need the consent of the person receiving the feeding tube.

  When medical professionals are confronted with deciding whether to remove a feeding tube, they must look at the patient's medical condition and the likelihood of his eventual recovery.

  Patients having the feeding tubes placed are either elderly, mentally ill or they are patients unable to swallow food to receive nutrition. As of 1995, 121,000 patients had undergone PEG surgery. Remember that doctors have to consider how close their elderly patients are to the ends of their lives. When the patient has become so ill or deteriorated to the point where continued feeding would be pointless, the question becomes, "When do we remove the tube?"

  If you are facing a situation with an elderly relative, have a serious talk with his doctor about the reasons for considering removing PEG. Develop a list of questions covering every conceivable angle--will he ever make any improvement; is he close to death right now; is the tube feeding unnecessarily prolonging his life?

Legal Issues

• In addition to considering medical issues, talk to your relative's attorney and find out what legal rights she has. Ask her attorney if she ever filed a Living Will or any type of legal instrument spelling out what kinds of medical or surgical procedures would be performed on her. In an instance such as yours, you also must know whether she wanted to have her life prolonged in any way, including through artificial feeding.

  As you are talking to her attorney, let him know just how close to death your relative is. He may be able to advise you as to what your relative had in mind regarding tube feeding, the removal of her tube and the end of her life.

Ethical Issues

• As you are trying to make the right decision for your relative, remember that patient autonomy is a protected right. The Nuremberg Code, drafted in 1947, forbids doctors from performing unwanted medical procedures on patients. Under this principle of autonomy, your relative has the right to decide what treatments he wants and what treatments he does not want. The same principle applies in deciding to remove his feeding tube. You and his doctor have to agree on what is the right thing to do for him in making the decision to remove nutrition or not.

  Informed consent protects patient autonomy. In the event that your relative is unable to give informed consent, you must make this decision for him.

  Ultimately, you must make the decision based on your relative's values. Again, this is where you must know what decisions your relative made regarding health care decisions and stopping nutritional intervention before he became incapacitated.