Life Sustaining Treatment
Tube Feeding (PEGs)
People who have a serious illness or are weak may sometimes have problems getting the nourishment we think they need for their body to function properly. Eating and/or swallowing become difficult. When this occurs, the doctor will try to find out what is causing the problem. If treatment or changes in the environment can be made to address this problem, the doctor will see that these changes are made. If the problem can not be addressed through these changes, the doctor will likely talk to the person and his or her family about tube feeding. One tube feed procedure involves placement of a PEG tube, a feeding tube placed through the skin into the stomach through a small hole in the abdomen.
Discussions with the Doctor about Tube Feeding
Before discussing tube feeding fully, the doctor will ask the person who is sick (or their loved ones if that person can not make a decision for themselves) about whether or not tube feeding is a procedure that they might be interested in. Usually, people have very strong feelings about tube feeding and often they have discussed their feelings with loved ones. The doctor will ask about whether the sick person has done any advance care planning whether they have completed a health care proxy or living will. The doctor will ask if the person has had any prior discussions with loved ones about health care preferences in situations like these. Making a decision about tube feeding is a difficult decision.
If you are making this decision for your loved one, it is important to distinguish what it is they would want for themselves if they could decide for themselves, and to separate that wish from what you would wish for them. It is their wish that should form the basis of the decision.
The Tube Feeding Decision
There are many aspects that need to be considered when making a decision about tube feeding. It is important to consider the advantages, disadvantages and other considerations of feeding tube placement. It is also important to look at the advantages, disadvantages and other considerations to continuation of hand feeding.
The questions you might ask in regards to this decision are:
Will my loved one live longer, or possibly die sooner, as a result of having a PEG tube placed?
Will the quality of their life improve and will that quality of life be something they would value?
Will placing a PEG allow for treatment that is likely to cure their underlying illness?
For example, using tube feeding for a person who had a stroke but was in good health prior to having it will lead to different results than using a tube feeding for a person who has Alzheimer’s disease.
Emotions often play a large role in the decision to tube feed. Feelings of guilt about “not doing everything in your power” to help the person and pressure from others may affect the decision making process. Finally, personal beliefs regarding tube feeding influence the decision as well. Health care spokespersons and family members have many questions to consider in making a decision about tube feeding. People who choose not to have tube feedings can be kept comfortable with small sips of liquid and lubrication of their mouths and lips. Most patients will not experience greater comfort because of tube feedings being started. Exceptions to this include some patients with acute injuries that impair their ability to swallow and some people with early cancers of the head and neck and esophagus.
If you and your family members have conflicting views about whether or not the person should have a tube feed placed, it is important to ask for help in making the decision. The doctor is available to meet with all family members together if this might be helpful. Perhaps a discussion with the chaplain or faith leader may help as well.
Tube Feeding Procedure
Placing a PEG tube usually takes about 15 minutes. It involves a number of steps. Liquid food is put into a bag that is delivering into the stomach through this tube.
Tube feeding can be done for a limited amount of time. When the decision is made to place the feeding tube, a decision can also be made that the use of the tube will be reviewed in 1 month or 2 or 3 to see if it is still the right thing to do. If it is felt that the original goals of tube feeding are not met, then a new decision can be made to discontinue the tube feeding.
Alternatives to Tube Feeding
Continuing to feed by mouth (feeding orally) is an option to inserting a PEG. Feeding by mouth also has its advantages and disadvantages. Eating allows a person the ability to enjoy the taste of food and have increased social interaction with others. However, is usually requires a longer period of time to feed someone who has problems eating or swallowing.