Must we all die with a feeding tube?

[URO-RN]

Thought provoking article:

http://www.bioethics.net/articles.php?viewCat=2&articleId=62

or

http://www.msnbc.msn.com/id/4669899/

[NotMyName]

What if the patient experiences paralysis which renders PO intake impossible, declines PEG tube, yet is still experiencing hunger and thirst? Good mouth care can be helpful. Sedation may at some point be necessary. Any suggestions to decrease patient discomfort?

[kidsnstudyn]

There is a book written by an "actual" doctor from Columbus OH who deals with this end of life issue. "A Death Prolonged" by Jeff Gordon, MD. It's written as fiction, and he's not necessarily a gifted writer, but it is an interesting story that makes you think. And made me want to update my husbands and my will, living will, and Medical POA - not in a depressing way, but a let's-get-this-done way.

Katie:D

[kidsnstudyn]

Wow, I didn't know this was such an old thread. Sorry.

[talaxandra]

No worries - it's still a relevant topic :)

[Chico David, BSN, RN]

And since this has popped up again as a live topic, I thought I would share some stuff I put in my own advance directive.

We often heare patients say things like "I don't want to be on a machine" or "I don't want life support". But when the critical intervention is something like a feeding tube or a medication, that can be a much harder decision for families to figure out. When I did my own document, I did not use one of the commonly available forms. I got a program called "Will Maker" that I ordered online. It can help you with all the common documents you might need in preparing for the end of your life, including a medical advanced directive. Among other things, it allows you to create a statement of your own beliefs that goes far beyond the check boxes on the average form. Here's what I put in mine: (obviously, 29 years of nursing helped in knowing what to write.)

Personal Values Regarding End-of-Life Decisions

It is my belief that two fundamental components of human life are cognition and communication. Without these two, there is no truly human life, merely vegetative existance. I would ask that my agent and caregivers are mindful of this belief in any decision making regarding my care.

Other Wishes Regarding My Health Care

Should I become incapacitated by reversable acute illness or trauma, I would wish the maximum of treatment as long as there is a reasonable chance of a return to full functioning. I am willing to tolerate arduous treatment as long as there is a reasonable hope for full or nearly full recovery. Should there be little chance of recovery, I would not want life sustaining treatment and would want maximum relief of discomfort, even at the risk of shortening life.

Should I become incapacitated as a part of the normal process of aging or the progression of chronic illness, I would not want life sustaining treatment and would want palliative care and maximal relief of discomfort even at the risk of shortening life. I would specifically approve the use of opiates for relief of shortness of breath even at the risk of suppressing adequate respiration and shortening life.

For purposes of the above, I consider "life sustaining treatment" to include not only CPR and artificial ventilation, but also artificial hydration and nutrition, antibiotic treatment, inotropic and pressor agents, renal dialysis and oxygen by mask or cannula