Pro's/Cons of artificial feeding (for college essay)

danu3 · Apr 6, 2005

http://www.mywhatever.com/cifwriter/library/mortals/mor0.html

The mortals handbook. Look at section 11.1 on tube feeding as it goes in briefly when it is appropriate.

http://www.permanente.net/kaiser/pages/c6145-15233.html

This is where I found the Mortals handbook. There may be other links in there that might be interesting to your paper.

What else, gastric feeding tube is a medical procedure. Philosophically, lots of people make an distinction between ordinary means and extra ordinary means and whether gastric feeding tubes belong to one or another. Medically, you don't have this, it is whether it involve a medical procedure or not.

Another thing you can look at is whether a procedure is prolonging life or prolonging suffering. In reality, it is not one or the other. It is really more a question of whether the prolonging life part is outweighing the prolonging suffering part and at what point it crosses over (this is a grey area). Now of course, you are going to run into a sticky problem in defining "life" and "suffering".

You might want to take a look at Hospice philosophy as they deal with this all the time. Basically their philosophy is they do not speed up or slow down death (not intentionally in either direction). Plus it is a philosophy of helping the client live his/her fullest till the very end (this exclude euthanasia on one end and just prolonging physical life for the sake of prolonging physical life regardless of the disease stage on the other end). Usually living life to one's fullest in Hospice involve healing of relationships, spending quality time with love ones and so on.

So if you get your hand on a Hospice nurse, that might be interesting. Or someone in the palliative care area also will be interesting.

-Dan

gwenith, BSN, RN · Apr 6, 2005

What you must remember is that artificial feeding is just that. PVS patients are not only unable to swallow but often do not even have the reflex to attempt to do so (Though occasionally you do see a sucking reflex emerge and beleive me there is a LOT of brain damage for that to occur).

I think your first step would be to look at what PVS means and what it stands for. Understand the condition and the question is then not about artificial feeding but to what lengths should we go to continue a life without hope of recovery/improvement and without cognition??

danu3 · Apr 6, 2005

I think your first step would be to look at what PVS means and what it stands for. Understand the condition and the question is then not about artificial feeding but to what lengths should we go to continue a life without hope of recovery/improvement and without cognition??

That is a good suggestion. When you look at PVS, do not dismiss the emotional aspect of it for this actually is the most powerful part in making decisions as to whether to provide life support or not. Especially if the person have sleep cycles and blinks and in some cases, even have to seemingly ability to temporary tract object. A subtopic can deal with patient education of PVS not just at the clinical level, but also address the emotional level.

Another potential area you can address is are there ways we can prevent things like what happened to Terri in the first place? If not, are there ways we can at least minimize the number of these kind of heartbreaking cases? In another word, we are going the preventive route if possible.

-Dan

gwenith, BSN, RN · Apr 6, 2005

I think the other thing to look at is the family acceptance of death. I nursed a case here where a young man was bashed and thrown in the river - he was rescued but even at rescue he had fixed pupils - we did the full nine yards save on him - full cerebral intervention save because he was a young uni student but we were left with a person in PVS suffering so much muscle spasm and hypertonicity that we could not keep the feeding regime up enough to prevent starvation (ironic isn't it?) this was despite maximal clonazepam etc. In what was almost a complete reverse of the Schiavo case his father confided to me that he wished we had not "saved" his son because the perpetrators of the bashing only got charged with Grievous Bodily Harm whereas if his son had died they would have been charged with murder. This man still loved his son - that was obvious - but he had accepted that the child he knew and loved had gone. It is called a "social death". The people around accept that the essence of the person - that part that they loved is no longer there.

jaimemds · Apr 9, 2005

You have been very helpful. Thank you sooooo much.

happy&healthy · Apr 18, 2005

Hi all,
I am currently back in college to get my RN (already an LPN) and I would like some input on other nurses thoughts on artificial feeding in regards to Persistent Vegetative state/coma, etc. I dont want this thread to be about the Terri Schiavo case> i would like nursing input on risk/benefit. the paper is an opinion paper with no emphasis on right or wrong opinion. All opinions are valid and respected in my paper. Another aspect of my paper is misunderstandings about feeding tubes and possibly more patient/physician education. All input is greatly appreciated. Thank you, Jaime

Hi Jaime,

THANK YOU for being open-minded, enough to "accept and appreciate ALL opinions as valid and respected".

And obviously evidently, individuals in "coma-state" are tragically mis-understood.

Might you agree -

1. the *coma-person, her/him-self* deserves the "RIGHT of Choice" :) re living, or dying; and

2. NOT the physicians, family, and other unbelieving public opinions.

One critical issue that people, who are FOR "withdrawal-of-support" are not considering, nearly adequately enough, is: "Eliminating someone else is good, I'm SURE that's what I would want - if I was in a coma state". Ah, but 99.9% of these people haven't ever been IN that state, so - they're not speaking from 1st-hand experience, are they.

Continue carefully researching this issue Jaime, because

as *open-minded* as you are, you might yet come to understand

how, specifically, to help such people....... before some other public figure succeeds in preventing

another's QUALITY-of-life.

Learn being an *ardent Advocate-for-QUALITY-of-life.*. Such is noble, Jaime.