Classwork; Limitations on Feeding Tubes

Aaron Tejada

ENG 201

03/06/20

Imagine if someone close to you has slipped into a coma and you are told that even if he or she does wake up, he or she will be “brain-dead.” As heartbreaking as that may be, what if the person’s life was in your hands?  What if the solution of keeping the person alive by placing the individual on a feeding tube was presented?  Pathos (Page 1)- This is pathos because it grabs the reader’s attention by using their emotion, making them think about a close friend or relative being brain dead.

 

 How long would you wait for the person to awake from the coma? It is the role of doctors to prolong the lives of patients and carefully plan out the patient’s medical recovery.  Kairos (Page 1)- This is kairos because it lets us know the situation has a time limit, their lives are on the line.

 

The goal of a feeding tube is to provide patient’s nutrition while they undergo an ongoing recovery; thus, in many ways the feeding tube is used as a treatment.  The Center for Bioethics and Human Dignity states a similar view in an article published by Dr. John Dunlop. Dunlop states that: “Most clinicians would recommend feeding tubes when there is a reversible process that temporarily prevents oral feeding, such as after esophageal surgery. Similarly, there are very few who would recommend tube feeding when the patient cannot eat because of an esophageal blockage caused by an untreatable cancer. This spectrum of conditions forces the question of where to draw the line” (Dunlop, 2006).  Therefore, feeding tubes are intended for patients who require nourishment because of an inability to consume food.  Ethos (Page 2) This is ethos because it provides an explanation of what the feeding tube’s role is and is backed up by a doctor.

 

 Her parents wanted to keep her alive for as long as possible, and her husband who was her primary caregiver thought it was demeaning to keep her alive for more than fifteen years, if she was suffering while on the feeding tube. Pathos (Page 3)- This is pathos because it’s emotional to think about having a family member alive for 15 years through a feeding tube knowing she’s suffering and most likely not coming back.

 

According to the Mayo Clinic it is stated that: “tube feeding supplies the body with nutrients and fluids intravenously or via a tube in the stomach. Decide if, when and for how long you would want to be fed in this manner” (Mayoclinic.org, 2014). Thereby, in an advance directive people let the medical caregivers and their families know whether or not they would like to be fed artificially via feeding tubes. Physicians must follow the advance directive when planning the care for a patient who is faced in a life or death situation. Some patients want to be on feeding tubes for a certain period of time before they are disconnected.  Advance directives and other legal documentation allow physicians to make concrete decisions such as whether or not to place a patient on a feeding tube. Logos (Page 2)- This is logos because it explains a logical approach of how the feeding tube situation is handled, it’s kind of like a will whether patients want to do it or not.

 

Feeding tubes should not be used for more than ten years for patients with progressive terminal illnesses because the use of the feeding tube may increase that patient’s agony. Kairos (Page 4)- This is kairos because it establishes the problem of keeping people on a feeding tube over time with a terminal illness, it’s a timely issue.

Feeding tubes are often seen in patients who have suffered from neurological conditions such as dementia. Yes, many times it is actually suggested by physicians in nursing homes that patients with dementia be put on feeding tubes so they maintain their health. Although feeding tubes are essential in these cases, Dr. Li of Thomas Jefferson University Hospital states that: “…studies have shown that feeding tubes are of unproved benefit in ensuring adequate nutrition, preventing pressure sores, preventing aspiration pneumonia, providing comfort, improving functional status, or extending life in patients with advanced dementia. The procedure can be burdensome through tube-related complications and the use of restraints” (Li, 2002).  Ethos (Page 4)- This is ethos because it is backed up by a expert in the field with both sides of the argument.

Limitations on Feeding Tubes

        Imagine if someone close to you has slipped into a coma and you are told that even if he or she does wake up, he or she will be “brain-dead.” As heartbreaking as that may be, what if the person’s life was in your hands?  What if the solution of keeping the person alive by placing the individual on a feeding tube was presented?  To most people, feeding tubes would be an obvious choice; however, another question would arise soon thereafter. That question would be:  how long would you wait for the person to awake from the coma? It is the role of doctors to prolong the lives of patients and carefully plan out the patient’s medical recovery.  Thus, many times feeding tubes are offered as a solution to keep patients nourished while they are unable to intake food orally. Feeding tubes are often offered to patients who develop neurological diseases such as dementia and also provided to stroke survivors who are often unable to open their mouths. Feeding tubes are necessary to aid in improving patient’s heaths’; however there are cases when patients have irreversible conditions and are placed on feeding tubes. In cases such as irreversible brain damage or comatose state for a prolonged time period, is it ethical to keep patients alive? There are studies that suggest feeding tubes actually may deteriorate a patient’s health; subsequently, many questions have surfaced, such as when is it appropriate to unplug the feeding tube?  It is necessary to have the option to put patients on the feeding tubes, especially to patients who have faced life threatening conditions; however, if the patient does not have an advance directive and has been unconscious or comatose for a prolonged period of ten years with no signs of progression, then keeping the patient on a feeding tube is unethical.   

       There are patients who have advance directives or living wills that state what they would want to happen if they are faced with an adverse situation such as brain damage or comas. A part of the living will is whether or not a person wants to be placed on a feeding tube. According to the Mayo Clinic it is stated that: “tube feeding supplies the body with nutrients and fluids intravenously or via a tube in the stomach. Decide if, when and for how long you would want to be fed in this manner” (Mayoclinic.org, 2014). Thereby, in an advance directive people let the medical caregivers and their families know whether or not they would like to be fed artificially via feeding tubes. Physicians must follow the advance directive when planning the care for a patient who is faced in a life or death situation. Some patients want to be on feeding tubes for a certain period of time before they are disconnected.  Advance directives and other legal documentation allow physicians to make concrete decisions such as whether or not to place a patient on a feeding tube. The problem is when such legal writing is not available.

       The goal of a feeding tube is to provide patient’s nutrition while they undergo an ongoing recovery; thus, in many ways the feeding tube is used as a treatment.  The Center for Bioethics and Human Dignity states a similar view in an article published by Dr. John Dunlop.  Dunlop states that: “Most clinicians would recommend feeding tubes when there is a reversible process that temporarily prevents oral feeding, such as after esophageal surgery. Similarly, there are very few who would recommend tube feeding when the patient cannot eat because of an esophageal blockage caused by an untreatable cancer. This spectrum of conditions forces the question of where to draw the line” (Dunlop, 2006).  Therefore, feeding tubes are intended for patients who require nourishment because of an inability to consume food.

         The application of feeding tubes for a prolonged period of time is often discouraged by physicians. Many comatose patients who don’t show any signs of recovery are kept alive for decades and this can actually be agonizing for those patients. A national case that feeding tubes were the center of debate was a case known as the Terri Schiavo Case in 2005. An article published in the MIT press known as: “On Feeding Tubes,” by Patrick Anderson, outlined Schiavo’s case.  The article states that Terri Schiavo was a woman who suffered significant brain damage and was declared to be a permanent vegetative state (Anderson, 2005, p. 1) .The article goes onto state that Terri Schiavo was kept on a feeding tube for fifteen years and that her parents and her husband became involved in a bitter argument on whether she should be allowed to “pass on”(Anderson, 2005, p. 1). Her parents wanted to keep her alive for as long as possible, and her husband who was her primary caregiver thought it was demeaning to keep her alive for more than fifteen years, if she was suffering while on the feeding tube. Cases such as Schiavo’s are the forefront of the feeding tube dilemma. The expert opinions from her doctors were that her mental state denied the nature of the feeding tube as a life support and ignore the medical evidence that she became absolutely unconscious before experiencing a painless death (Anderson, 2005, p. 8). Medical doctors believed that Schiavo suffered for over ten years and the feeding tube did not improve her health at all.

The aftermath of the 2005 Schiavo Case brought upon a poll by CBS News that asked Americans on life or death decisions.  In 2005, according to CBS News, the majority of eighty two percent of Americans would want their feeding tube removed if they were faced with a comatose state (Cosgrove-Mather, 2005). Another key question was brought upon in the discussion of life or death decisions in the CBS News poll conducted in 2005; it is presented in the figure below:

IF PATIENT IS IN A COMA, SHOULD CLOSE FAMILY MEMBER BE ABLE TO HAVE DOCTOR REMOVE THE FEEDING TUBE AND LET THE PERSON DIE?

Should

 73% 2005
 81% 1990

Should not
 17% 2005
 13% 1990

Figure 1: Poll done by CBS News asking if a patient is in a coma, should a close member be able to doctor remove the feeding tubee and let the person die? (Cosgrove-Mather, 2005).

      The bar graph above (Figure 1) depicts the results of the same poll that was conducted. It shows that the question was whether the family members should have the right to tell the doctor to remove the feeding tube and let the patient die. The results depict that seventy three percent of Americans in 2005 responded and said “yes,” that if a patient is in a coma with no brain activity, a close family member should have the right to tell the doctor to remove the feeding tube and let the patient die (Cosgrove-Mather, 2005). Therefore, it is seen by these results that most Americans believe that feeding tubes should not be a method to prolong life if the patient is in a coma with no brain activity.

           Feeding tubes are often seen in patients who have suffered from neurological conditions such as dementia. Yes, many times it is actually suggested by physicians in nursing homes that patients with dementia be put on feeding tubes so they maintain their health. Although feeding tubes are essential in these cases, Dr. Li of Thomas Jefferson University Hospital states that: “…studies have shown that feeding tubes are of unproved benefit in ensuring adequate nutrition, preventing pressure sores, preventing aspiration pneumonia, providing comfort, improving functional status, or extending life in patients with advanced dementia. The procedure can be burdensome through tube-related complications and the use of restraints” (Li, 2002).  Thus, even in cases with patients who have advanced dementia, feeding tubes are more burdensome than beneficial.
        Feeding tubes should not be used for more than ten years for patients with progressive terminal illnesses because the use of the feeding tube may increase that patient’s agony. According to The Center for Bioethics and Human Dignity it is stated that:

The operative words are “progressive terminal illness,” which would include such conditions as cancer; kidney, heart, or lung failure. It would also include dementia and advanced age. It does not include someone who is stable though disabled after a brain injury or stroke. In the context of progressive terminal illness it can be argued that tube feeding should generally not be done. When the patient dies the ultimate cause of death is the underlying disease, not starvation or dehydration. (Dunlop, 2005)

The Center for Bioethics suggests that people who are already facing terminal illnesses and should not be put on feeding tubes. The reason why the issue is controversial is because the underlying cause of these seemingly fatal illnesses can be prevented if on a feeding tube.

The answer is that when a person is experiencing difficulties of living on a feeding tube and is continuing to suffer, feeding tubes should be discontinued after a number of years.

            Feeding tubes are intended for patients who are supposed to show recovery. If feeding tubes are used as purpose to give hope to patient’s families then it is unethical. Patients who are in comatose states or perhaps patients who are completely brain damaged for periods greater than ten years should be able to rest with dignity instead of being kept alive by feeding tubes. It is wrong to subject the lives of patients to this method for more than ten years. It is wrong to give hope to families may that rely on these feeding tubes to be a recovery method for patients with irreversible damages to their health.

 

 

 

 

Works Cited

Anderson, Patrick. "On Feeding Tubes." The MIT Press 49.3 (2005): 5-9. JSTOR. Web. 11 Oct.     ____2014.

Cosgrove-Mather, Bootie. http://www.cbsnews.com/news/poll-keep-feeding-tube-out/. N.p., 23 _____Mar. 2005. Web. 11 Oct. 2014.

Dunlop, John T. cbhd.org. Trinity International University, 27 Jan. 2006. Web. 11 Oct. 2014.

 

Li, Ina. aafp.org. American Family Physician , 12 Apr. 2002. Web. 11 Oct. 2014.

http://www.mayoclinic.org/healthy-living/consumer-health/in-depth/living-wills/art-20046303?pg=2. MayoClinic, 11 July 2014. Web. 11 Oct. 2014.