MAKING DECISIONS ABOUT TUBE FEEDING FOR SEVERELY DEMENTED PATIENTS AT THE END OF LIFE: CLINICAL, LEGAL, AND ETHICAL CONSIDERATIONS

Death Studies ◽  
2000 ◽  
Vol 24 (3) ◽  
pp. 233-254 ◽  
Author(s):  
James M. Hoefler
Keyword(s):  
End Of Life ◽  
Tube Feeding ◽  
Ethical Considerations

Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations

2018 ◽  
Vol 45 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Lori Seller ◽  
Marie-Ève Bouthillier ◽  
Veronique Fraser
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Issues ◽  
Retrospective Chart Review ◽  
Median Number ◽  
Life Care ◽  
Ethical Considerations ◽  
Term Care ◽  
Medical Aid ◽  
Aid In Dying

BackgroundMedical aid in dying (MAiD) was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.MethodsA retrospective chart review of all MAiD requests between December 2015 and June 2017 at two Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.ResultsOf 80 patients requesting MAiD, 54% (43) received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults (32%) came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 (prolongation of life remains a priority) at the time of the MAiD request and 19% were receiving life-prolonging interventions.InterpretationWe highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend.

scholarly journals Managing Eating Disorders in Elderly with Dementia and the Ethical Considerations for Tube Feeding

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Quality Of Life ◽  
Eating Disorders ◽  
Management Strategies ◽  
Tube Feeding ◽  
The Elderly ◽  
Feeding Tube ◽  
Medical Complications ◽  
Ethical Considerations ◽  
Nutritional Needs

As dementia progresses, the elderly with dementia often have difficulties finishing their meals and weight loss is a common feature at this stage of their dementia journey. Eating disorders cause tremendous caregiver stress and burden. In considering provision of best care for this group of elderly, the hospital is probably not the best place and yet, they are frequently brought in to the hospital to seek help for fever, pneumonia, dislodged feeding tube, medical complications arising from poor feeding and dehydration. It is important to understand the aetiology of poor feeding among this group of patients and advise the patients and their family on the appropriate management strategies to improve the intake of food and to maximize their quality of life. At this stage of dementia, focusing on means to ensure nutritional needs are met may end up causing further harm and distress.

scholarly journals Preferences for Advance Directives in Korea

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
So-Sun Kim ◽  
Won-Hee Lee ◽  
JooYoung Cheon ◽  
Jung-Eun Lee ◽  
KiSun Yeo ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
End Of Life Care ◽  
Healthcare Providers ◽  
Tube Feeding ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Korean People ◽  
End Stage

Background. The goal of advance directives is to help patients retain their dignity and autonomy by making their own decisions regarding end-stage medical treatment. The purpose of this study was to examine preferences of advance directives among general population in Korea.Method. A descriptive cross-sectional survey was performed from October 2007 to June 2008 in Seoul, Korea. A total of 336 city-dwelling adults self-administered the questionnaire and returned it via mail. Data analyses were conducted using SPSS 17.0.Results. Subjects reported the need for healthcare providers' detailed explanations and recommendations regarding end-of-life care. When there is no hope of recovery and death is imminent, most subjects did not want to receive cardiopulmonary resuscitation nor an IV or tube feeding. However, most of the subjects wanted pain management care.Conclusions. The present study showed that many Korean people have an interest in advance directives. The results show that the autonomy and dignity of patient have increased in importance. To provide better end-of-life care, there is a need to educate patients on the definition and intent of an advance directive. Additional proactive communication between patients and their caregivers should be educated to healthcare providers.

Palliative and end-of-life care

2020 ◽  
pp. 395-408
Author(s):  
Elizabeth Sampson ◽  
Karen Harrison Dening
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Terminal Illness ◽  
Mental Health Problems ◽  
Tube Feeding ◽  
Spiritual Needs ◽  
Ageing Population ◽  
Life Care ◽  
Anticipatory Grief ◽  
Poor Access

Our ageing population and changes in cause of death mean that increasing number of people will die in old age. In many countries, older people have had poor access to good-quality end-of-life care. Many will develop multiple comorbidities associated with age—dementia, mental health problems, and general frailty. Palliative care is an approach that aims to relieve suffering and take account of a person’s physical, psychosocial, and spiritual needs as they near the end of life. Advanced dementia is now being perceived as a ‘terminal illness’. Interventions such as antibiotics and enteral tube feeding remain in use despite little evidence that they improve quality of life or other outcomes. A person-centred approach from a multi-disciplinary team is vital in providing good-quality end-of-life care in a range of settings. The acknowledgement of anticipatory grief and provision of bereavement support are vital for some family carers.

scholarly journals Deep Brain Stimulation at End of Life: Clinical and Ethical Considerations

2020 ◽  
Vol 23 (4) ◽  
pp. 582-585
Author(s):  
Lauren R. Sankary ◽  
Paul J. Ford ◽  
Andre G. Machado ◽  
Laura J. Hoeksema ◽  
Renato V. Samala ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
End Of Life ◽  
Brain Stimulation ◽  
Ethical Considerations ◽  
Deep Brain

Challenges faced by patients, relatives and clinicians in end-stage dementia decision-making: a qualitative study of swallowing problems

2020 ◽  
pp. medethics-2020-106222
Author(s):  
Joseph Dimech ◽  
Emmanuel Agius ◽  
Julian C Hughes ◽  
Paul Bartolo
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Ethical Issues ◽  
Tube Feeding ◽  
Care Plan ◽  
Term Care ◽  
Swallowing Problems ◽  
Swallowing Difficulties ◽  
Life Threatening ◽  
End Stage

BackgroundDecision-making in end-stage dementia (ESD) is a complex process involving medical, social, legal and ethical issues. In ESD, the person suffers from severe cognitive problems leading to a loss of capacity to decide matters regarding health and end-of-life issues. The decisional responsibility is usually passed to clinicians and relatives who can face significant difficulty in making moral decisions, particularly in the presence of life-threatening swallowing problems.AimThis study aimed to understand the decision-making processes of clinical teams and relatives in addressing life-threatening swallowing difficulties in ESD in long-term care in Malta.MethodThe study followed a qualitative approach where six case studies, involving six different teams and relatives of six different patients, were interviewed retrospectively to understand their decision-making in connection with the management of swallowing difficulties in ESD. Data were collected through semistructured interviews with each stakeholder. All data were transcribed and subjected to thematic analysis.ResultsFour themes were identified: the vulnerability of patients in dementia decision-making; the difficult role of relatives in decision-making; the decisional conflict between aggressive care through tube feeding versus oral comfort feeding; a consensus-building decision-making process as ideal to facilitate agreement and respect for patient’s dignity.ConclusionDecision-making to manage swallowing difficulties in ESD is a challenging process, which involves an interpretation of personal values, beliefs, patient preferences, care needs and clinical practice. Better communication between clinicians and relatives in dementia helps promote agreement between stakeholders leading to a care plan that respects the dignity of patients at their end of life.

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