Table 1.

Analysis of ethical considerations for the insertion of PEG tubes in patients with dementia

Conscience	Assesses patients with dementia for nutritional deficiencies on an individual basisInvolves a multiprofessional nutrition team wherever possible in nutritional support decision makingAssesses patients promptly and makes timely decisions
Compliance	Complies with local protocols for multidisciplinary team decisions regarding nutritional supportComplies with the Mental Capacity Act 2005, including valid advance decisions and lasting powers of attorney
Concurrence	Acknowledges and respects patient's and family's views on appropriateness of PEG tube insertion
Conversation	Communicates effectively with patients, carers and family about risks, benefits and alternatives of PEG feeding in demented patientsMaintains balanced/neutral viewpoints where possibleEmpathises with patients, families and carers when discussing nutritional support
Conversion	Explains alternatives to PEG feeding (eg, hand feeding and oral modifications)Allows time for family to consider alternatives providedAble to negotiate sensitively around previous information given to family about nutritional support