Is it ethical to provide enteral tube feedings for patients with dementia? by ProQuest

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Results indicated that 75% of these patients did not want enteral tube feedings if mild dementia was diagnosed, and 95% did not want enteral tube feedings if severe dementia was diagnosed.3 Four main bioethical principles must be considered when discussing the use of enteral tube feedings in patients with dementia.4,5 Autonomy The ethical community and court system have consistently maintained that a patient has a right to refuse artifi cial nutrition and hydration. 6 Often, though, in the case of a patient with dementia, the responsibility of medical decision making falls on the patient's medical power of attorney. The clinician must ask, "Does placing an enteral feeding tube harm the patient?" Or, conversely, "Does not placing an enteral feeding tube harm the patient?" The Cochrane review found only two studies that reported adverse events, and those events were statistically insignifi cant.7 The review recommended further investigation.7 In addition to the procedural complications, fi stula formation and inadvertent tube dislodgement are common long-term complications of enteral feeding tube placement.2 One study found that the average life span for enteral feeding tubes in geriatric patients was 3.8 months.9 Moreover, an editorial by Gillick highlighted that the most serious consequence of enteral feeding tube placement is the need for chronic restraint use.10 In one study, 71% of patients with dementia and enteral feeding tubes required restraint use to avoid inadvertent removal.11 Whether patients are harmed by not placing enteral feeding tubes is impossible to know.

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