Do feeding tubes inflict pain and suffering?

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A relative who is in advanced stages of Altzheimer’s disease was recently hospitalized for the flu. He recovered from the flu but the doctor told the caregiver that he was not taking in enough calories to sustain his nutritional needs on a daily basis and recommended that a feeding tube be inserted. The caregiver refused the idea of a feeding tube. Caregiver says that as long as the patient is feeding himself then we should let nature take its course. Caregiver believes that a feeding tube would be inflicting physical pain on the patient who would then need to be on heavy pain meds. Caregiver also believes that patient would try and pull the feeding tube out. Can this even happen?

Would a feeding tube in this situation be considered “extraordinary means” or is caregiver denying the patient the ordinary, necessary means of nutrition and care??

Am I wrong to believe that what is taking place is a slow, yet natural way of starvation? The patient has lost considerable weight over the past few months – a result, I’m sure of the low caloric intake (although I’m no doctor so what do I know?).

Thanks for your comments.
 
DVIN_CKS said:
A relative who is in advanced stages of Altzheimer’s disease was recently hospitalized for the flu. He recovered from the flu but the doctor told the caregiver that he was not taking in enough calories to sustain his nutritional needs on a daily basis and recommended that a feeding tube be inserted. The caregiver refused the idea of a feeding tube. Caregiver says that as long as the patient is feeding himself then we should let nature take its course. Caregiver believes that a feeding tube would be inflicting physical pain on the patient who would then need to be on heavy pain meds. Caregiver also believes that patient would try and pull the feeding tube out. Can this even happen?

Would a feeding tube in this situation be considered “extraordinary means” or is caregiver denying the patient the ordinary, necessary means of nutrition and care??

Am I wrong to believe that what is taking place is a slow, yet natural way of starvation? The patient has lost considerable weight over the past few months – a result, I’m sure of the low caloric intake (although I’m no doctor so what do I know?).

Thanks for your comments.
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If this is being done to basically force feed a person IMO it is an extraordinary means and done for the convenience of others.

When a person is no longer able to consume food normally AND has chosen for him/herself to make use of this tool, then IMO it is ordinary care.
 
I should add that this patient cannot communicate verbally and has lost most of his hearing. It is difficult to know how much - if any - information the patient understands given his advanced state of Altzheimer’s. In other words…he cannot “choose” whether he wants a feeding tube for himself. 🤷
 
From my experience from using feeding tubes in my (animal) patients, they are quite well tolerated, and not painful in the least. Not to directly compare animals to humans, but on some level a human that isn’t able to understand what’s happening to them is very similar to a pet who cannot understand same.

“If this is being done to basically force feed a person IMO it is an extraordinary means and done for the convenience of others.”

It’s my understanding that similar to pets, people who are in a state of dementia are likely to pull out a feeding tube; perhaps some caregivers can affirm this?

We generally don’t (at least the patients under my care) allow an animal to slowly starve themselves to death. Why on earth would we allow the same for a person??
 
I posted this question to the AA forum. I’m hoping for some clear guidance. Perhaps I should call a priest. :confused:
 
I have a son who was fed via a nasal/gastric tube for many years before he died. He was in a vegetative state, but I think he felt pain at some level.

Anyway, he tolerated the tube quite well. If the choice is between starving/dehydrating and using the tube, I believe the answer is clear. The Church, I believe, talks about looking at whether the treatment would be “overly burdensome” on the caregiver or the patient.

This is just food and drink. I would think you have to TRY the NG tube (goes down the nose into the throat and into the stomach. Stays in for the feeding and is removed, or could stay in for a few days, if I remember correctly.) at least. Providing nutrition is not extraordinary means to keep someone alive.

I think the caregiver is overburdened. Perhaps they need help?
 
DVIN_CKS said:
I should add that this patient cannot communicate verbally and has lost most of his hearing. It is difficult to know how much - if any - information the patient understands given his advanced state of Altzheimer’s. In other words…he cannot “choose” whether he wants a feeding tube for himself. 🤷
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But it seems he can choose to eat from your account.

It takes more effort to provide more nutrient packed options but so long as the person eats on their own a feed tube would be for the care giver’s/doctor’s convenience.
 
The Vatican Congregation for the Doctrine of the faith recently responded to these situations in a doctrinal note:

Responses to certain Questions Concerning Artificial Nutrition and Hydration

They also issued some commentary that further clarifies this doctrinal note:

Commentary

I highly recommend reading both documents.

The doctrinal note basically says:
(1) Yes, the administration of food and water even by artificial means (i.e. a feeding tube) is morally obligatory.
(2) No, the feeding tube may not be removed because a patient is in a permanent vegetative state.

The Commentary goes into further detail.

Generally speaking, nutrition and hydration (i.e. food and water) are considered ordinary care. They are not medicinal.

The second to last paragraph of the Commentary lists some exceptions to this general principle:
(1) In remote or impoverished areas where it is not possible to utilize artifical means
(2) When the patient is unable to assimilate food and liquids
(3) When the use of these artificial means causes undue burden and/or complications.

It is important to note that they stress that these are exceptions to the rule and they are not the norm. Many people would like to claim “undue burden” for cases that clearly do not qualify.

Hope this helps!
 
An NG tube was tried while the patient was in the hospital but he yanked it out. Putting the patient on a feeding tube would be burdensome in the sense that he is in a facility that will not keep him if he has to be on a feeding tube (they don’t have the trained staff). Which means he’d have to be moved to a more skilled type of facility like a nursing home. This is something that isn’t a popular idea with the family. I think the caregiver’s motives are genuine…she wants to avoid causing any unnecessary pain and suffering on the patient. However, I agree that basic nutrition isn’t exactly an “unnecessary” treatment option. Hospice has been called in and they agree that the patient meets the criteria for their care. This usually means that the patient isn’t expected to live for more than six months. Would Hospice be able to advise the family on this matter?
 
Joe,
Thanks for the links. I will take a look. Your comments along with the rest have been very helpful.
 
Eilish,
Actually, I think the feeding tube isn’t being seen as a “convenience” but rather a burden in this situation.
 
DVIN_CKS said:
An NG tube was tried while the patient was in the hospital but he yanked it out. Putting the patient on a feeding tube would be burdensome in the sense that he is in a facility that will not keep him if he has to be on a feeding tube (they don’t have the trained staff). Which means he’d have to be moved to a more skilled type of facility like a nursing home…
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I don’t believe that this is what the Church means by “undue burden”. Having to move the patient to a different facility seems to be more of a burden for the family than for the patient (although, it seems possible that in some circumstances, moving the patient could be life-threatening, in which case it would seem the facility should be obligated to provide food and water by artificial means).

By “burden”, the Church is speaking more in regards to situations where the patient is experiencing great pain because of it. Last year, a member of my family had a feeding tube and it was difficult to insert and was causing severe irritation of her throat. That is the type of thing that is meant by burden (at least, that is how I understand what the Church is saying).

Basically, it comes down to respecting the dignity of the human person. Allowing someone to starve to death does not respect their dignity.
 
Generally speaking nutrition is considered ordinary treatment. It is only allowed to stopped when it is causing undue suffering like in a patient who is dying of cancer and has already suffered shut down of organs for instance.
 
I guess my question is IF the feeding tube causes pain and causes the patient to suffer more because of its insertion, is that grounds to not use it? Would that constitute “undue burden” on the patient?

I think this is a tricky situation since the patient is able - at least at the moment – to feed himself by mouth. He doesn’t eat enough by mouth to sustain his nutritional requirements which is why the doctor suggested a feeding tube be used.
 
DVIN_CKS said:
I guess my question is IF the feeding tube causes pain and causes the patient to suffer more because of its insertion, is that grounds to not use it? Would that constitute “undue burden” on the patient?

I think this is a tricky situation since the patient is able - at least at the moment – to feed himself by mouth. He doesn’t eat enough by mouth to sustain his nutritional requirements which is why the doctor suggested a feeding tube be used.
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A person needs only object to an invasive technique for it to be reason not to use it.
 
Based on my personal experience, I would say, only do it if there is absolutely no other way to feed the person. Otherwise, make sure he has access to nutritious snacks whenever he wants them, so that he can eat whenever he feels like it, small amounts at a time, instead of having to sit down to a big meal at particular times of the day.

If he is simply not taking food, it’s possible that he is not able to digest it (if he is in the process of dying, it is possibly that his digestive system is already shutting down), or that his nutritional needs are not as great as they once were. (I am assuming this is being investigated?)

My experience from my grandmother going through this is that a feeding tube is extremely inconvenient - imagine being in the middle of swallowing for a long period of time, and also being attached to whatever the feeding tube is attached to - and In her case, it also did something to her throat, and she was never able to speak again.
 
DVIN_CKS said:
I guess my question is IF the feeding tube causes pain and causes the patient to suffer more because of its insertion, is that grounds to not use it? Would that constitute “undue burden” on the patient?
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That’s probably a question that can only be answered on a case-by-case basis. It seems that could potentially qualify as undue burden.

Have you talked any of this over with a priest? Your local priest might be able to give you advice more pertinent to your individual situation, particularly if he is familiar with you and your family.
 
DVIN_CKS said:
I guess my question is IF the feeding tube causes pain and causes the patient to suffer more because of its insertion, is that grounds to not use it? Would that constitute “undue burden” on the patient?

I think this is a tricky situation since the patient is able - at least at the moment – to feed himself by mouth. He doesn’t eat enough by mouth to sustain his nutritional requirements which is why the doctor suggested a feeding tube be used.
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Hi,

We faced almost exactly this situation a couple years back. My mother in law (in her 80s at the time) had been diagnosed with Alzheimer’s and gradually lost weight as she was able to feed herself less and less. We knew that she would gradually starve without added nutrition and did not hesitate to have a feeding tube inserted (a fairly routine procedure which seemed to produce little or no discomfort for her.) They began giving nutritional supplements, which worked well for her. She was, indeed, in a nursing home.

Be warned…monitor carefully the quantity of water/liquid the patient is receiving. When my MILs fluid intake decreased because she wasn’t really drinking much at meals anymore, she should have received more fluid via the tube; this didn’t happen because the doctor assumed she was still drinking at meals. She ended up with a nearly-fatal urinary tract infection that was completely preventable. You can be sure she was carefully monitored after that!

Towards the end of her life, when her system began shutting down, the tube feeding was discontinued, only because her digestion had essentially stopped and it would have been cruel to continue. However, she still received IV nutrition until the end. I could not imagine withholding hydration and nutrition, except in the most extreme of circumstances (can’t really think of any…)

God bless; it’s a tough situation.
 
I want to point out that the feeding tube my MIL had went straight into her digestive system - not through her nose or throat.
 
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