Must we all die with a feeding tube?

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hi all... i'm new to this site and nurse in the uk

i was surprised at something bill levinson said earlier in the thread... " i was actually going to have a feeding tube put into my father when he stopped taking fluids and nutrition". also, cwazycwissyrn said "my dads feeding tube was accidentally pulled out when he was extubated. we did not have it put back"

i am assuming that in both situations, both fathers were not conscious and therefore not able to consent to a feeding tube. in which case i ask, do relatives make the final decision about the insertion of feeding, or indeed any treatment, in the usa? i know in the uk, that the doctor would make the final decision based on the patients "best interests" (the uk doctors regulatory body have some excellent guidance), any known views of the patient, the opinions of the rest of the health care team and the views of relatives. a relative cannot insist on any treatment, although their views are considered.

look forward to your comments

in ltc, we constantly were dong stuff just because the family wanted us to, it was not unusual for this to be the case even when it trampled on the resident's rights. i am no longer in ltc. i cannot respond properly to legal issues though-- i mean, i can to an extent but someone else will be able to do it better, i am sure.
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Specializes in LTC,Hospice/palliative care,acute care.

I was surprised at something Bill Levinson said earlier in the thread... " I was actually going to have a feeding tube put into my father when he stopped taking fluids and nutrition". Also, cwazycwissyRN said My dads feeding tube was accidentally pulled out when he was extubated. We did not have it put back".................................................Yes-things are very different here in the USA...We all have the right to self-determination but the laws regarding advance directives vary from state to state.I have seen these directives over-ruled by some physicians and have seen feeding tubes inserted because the family insisted even though the living will clearly stated "no tude feeding"..In the end it is really up to the physician because generally the Advance directive is applicable when the pateints condition is "terminal" according to the doc....So-an end stage Alzheimer's resident with an explicit advance directive stating no tube feeding,CPR,IV fluids and antibiotics may be treated numerous times for aspiration pneumonia.....Unless the patient has significant others that will advocate for them it just goes on and on.....

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.So-an end stage Alzheimer's resident with an explicit advance directive stating no tube feeding,CPR,IV fluids and antibiotics may be treated numerous times for aspiration pneumonia.....Unless the patient has significant others that will advocate for them it just goes on and on.....

Yes, Dad had several cases of aspiration pneumonia, and they wanted to put a feeding tube into him several months before I agreed it was necessary. I thought a tube would prevent him from eating (he was still eating) and enjoying his food; he seemed to like the vanilla soy ice cream I got for him. When he stopped eating completely, I thought it was because he was aspirating so much that eating was no longer a pleasant experience for him.

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Specializes in LTC,Hospice/palliative care,acute care.
Yes, Dad had several cases of aspiration pneumonia, and they wanted to put a feeding tube into him several months before I agreed it was necessary. I thought a tube would prevent him from eating (he was still eating) and enjoying his food; he seemed to like the vanilla soy ice cream I got for him. When he stopped eating completely, I thought it was because he was aspirating so much that eating was no longer a pleasant experience for him.
Bill-you did the best you could do for you dad...The Alzheimer's association does not endorse tube feeding...It is considered an act that prolongs dying-it does not support living....It is a shame that the medical community is not more in tune with dementia care-many doctors and nurses really seem to have a problem with palliative care in any case...I think the medical community jumps at inserting feeding tubes way too eagerly....I believe that our life can be supported through parenteral nutrition long enough to determine if we will have a meaningful recovery no matter what we are suffering from...I also think no church or politician needs to make that type of decision for us.We can register to vote when we renew our driver's license-why not complete an advance directive at that time? That would be a start....Death is such a part of life and needs to be embraced-it's the last "trip" we can plan...and we should....
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Yes-things are very different here in the USA...We all have the right to self-determination but the laws regarding advance directives vary from state to state.I have seen these directives over-ruled by some physicians and have seen feeding tubes inserted because the family insisted even though the living will clearly stated "no tude feeding"..In the end it is really up to the physician because generally the Advance directive is applicable when the pateints condition is "terminal" according to the doc....So-an end stage Alzheimer's resident with an explicit advance directive stating no tube feeding,CPR,IV fluids and antibiotics may be treated numerous times for aspiration pneumonia.....Unless the patient has significant others that will advocate for them it just goes on and on.....

I am quite shocked at this! In the UK an advance directive is legally binding through civil law and the govenment is in the process of consultation to make it statutory law. If a physician overruled an advance directive here, he could very well end up in court for assault and battery - probably more. Anyway, I doubt that many nurses would comply with the physician under these circumstances. Quite right too. We do get a lot of presure from relatives, but if the patient is quite clear about what they want, we abide by the decision... guess it is entirely different over here.

Do the medical insurance companies influence these decisions then?

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Bill-you did the best you could do for you dad...The Alzheimer's association does not endorse tube feeding...It is considered an act that prolongs dying-it does not support living....It is a shame that the medical community is not more in tune with dementia care-many doctors and nurses really seem to have a problem with palliative care in any case...I think the medical community jumps at inserting feeding tubes way too eagerly....

I am now very disappointed that the doctor (who rarely spoke with me anyway) did not explain these things to me. My father was opposed explicitly to anything that would merely prolong the dying process. I made the assumption, though, that lack of food and water (after he stopped taking them on his own) would result in severe discomfort and distress.

In fact, I visited him on the day he died and told him that I planned to have a tube inserted because I did not want him to be hungry or thirsty. I don't know if he understood me or not (he rarely showed any signs of consciousness) but in retrospect, it was probably something he would not have wanted, especially if he was beyond the ability to feel hunger or thirst.

His living will said he did not want his heart restarted if it stopped and I was in fact trying to get the doctor to certify that he had less than six months to live so the living will would take effect. As it was, the paramedics did try to revive him but they were unsuccessful which, given the circumstances and my father's wishes, was probably just as well.

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That was indeed my perception but, based on what I have seen here, it is probably better that Dad passed on before a tube could be inserted. I was actually trying to get the doctor to certify that he had less than six months to live (so his living will would go into effect; it said he did not want his heart restarted if it stopped) but I did not want Dad to be uncomfortable in the meantime, which I thought dehydration and lack of nutrition would cause.

I can also recall being ill and not wanting to eat anything but forcing myself to drink because I knew I needed it.

As a hospice RN the withholding of a feeding tube and/or IV hydration is common protocol. The body systems shut down near the last few weeks and food and water are not normally required. The kidneys are shutting down, noted by the darkness of the urine, and providing IV hydration and liquid feeding may lead to dangerous fluid overload. Oral care is CRUCIAL, positioning is CRUCIAL, skin care is CRUCIAL at this time. The body is not starving but is, instead, preparing to die. Feeding tubes also may lead to regugitation and aspiration. Even in nursing homes we know that after 5 years on a feeding tube that only sustains life it is time to remove it. It seems cruel to the family but this is where we all must research the information and provide good family teaching to assist them with coping. They usually are not familiar with the dying of a loved one and it is our duty to them to provide them with all the support, knowledge and understanding that we can. Advanced Directives/Living Wills are wonderful things for us to prevent unnecessary procedures being performed on us without our consent. Mine says any tube of any kind can be put in but after 2 months with no response remove everything and let my family go in peace.

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Specializes in Government.

Hey, Been There...great post. You said that better than I've ever seen it said.

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Whether you agree with the whole feeding tube/IV hydration issue or not, it just goes to show how important it is to have our wishes in writing before the situation presents itself. I think it is our job as healthcare providers to education our patients and their families on how important advanced directives are.

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According to Jeb Bush yes we must be fed by tube. Those Bush's just love telling us all what we're gonna do.

Jeb Bush is showing courage in the face of a society that wants all life to be perfect and planed. Life is a gift from God.Please check out this web site.http://www.terrisfight.org/

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Specializes in Medical.
Jeb Bush is showing courage in the face of a society that wants all life to be perfect and planed. Life is a gift from God.

And I'm happy for Jeb Bush to be tube fed for as long as he likes. I just don't want him deciding what kind of treatment I, or my loved ones, receive. He's not a doctor, he's not a nurse, he has no arcane knowledge and God hasn't handed him down stone tablets, so he can just butt out of my medical decision making.

Oh, and my God is a humanitarian who believes that suffering is not in and of itself a worthy thing. My God doesn't believe in life at any cost, and my God also believes that sometimes death is a gift.

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And I'm happy for Jeb Bush to be tube fed for as long as he likes. I just don't want him deciding what kind of treatment I, or my loved ones, receive. He's not a doctor, he's not a nurse, he has no arcane knowledge and God hasn't handed him down stone tablets, so he can just butt out of my medical decision making.

Did Terri Schaivo ever sign an advance directive? If so, did it say she did not want to be tube-fed?

There is also the issue that brain activity can be detected (from what I last read) so she is not legally dead. If she had suffered brain death, many states would treat her as legally dead and disconnect her.

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