For the second time in the past few months, an American medical journal has advocated ending the use of stomach tubes to feed people with advanced Alzheimer's disease and other types of dementia.
The latest article says that feeding tubes can cause a number of health problems, including diarrhoea, bloating, and infection (New England Journal of Medicine 2000;342:206-9). Moreover, patients with dementia frequently pull the tubes out, which leads nursing home and hospital staff to place them in restraints.
The author, Muriel Gillick, an associate professor of medicine at the Harvard Medical School and a staff doctor at the Hebrew Rehabilitation Center for the Aged in Boston, argues that it is both medically and ethically wrong to use feeding tubes in most cases.
Traditionally, says Dr Gillick, stomach tube feeding—which involves having a tube inserted through the nose or an incision in the abdomen—has been justified by the argument that it is the only way to save the patient from painful and even fatal thirst or starvation.
The families of patients are also told that the practice helps to avoid the risk of pneumonia or choking caused by food being inhaled into the lungs.
Dr Gillick says that the procedure has grown popular over the past 15 years because it no longer involves a major surgical procedure. “We are doing better and better at keeping people going longer and longer,” she noted. “But we are having a hard time acknowledging that there is a time to stop.”