Do feeding tubes inflict pain and suffering?

[KathleenElsie]

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?

My mother became very ill with the feeding tube. She was tried on six formulas and could tolerate none of them. She would pull out the nasal tube so the Dr placed one in hter stomach and that made her even sicker. I insisted they remove the tube, then I went into the nursing home and fed her four times a day the food I cooked at home. That was four years ago and mom now feeds herself and eats just fine. Had the feeding tube remained she would no longer be with us IMHO.

Also the only two nursing facilities that would take her with the tube were about 45 mile drive from us. This is considered specialized care.

 

[DVIN_CKS]

Thank you all so much for the comments. I will indeed talk this over with a priest for my piece of mind.

God bless!

 

[hasikelee]

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.

My hubby had a feeding tube when he was a child. He said it hurt very badly. He still has the scars.

I guess for you to have an answer, you would have to compare the pain of a feeding tube against the pain of starving to death.

Personally, I have a sneaking suspicion that starving until your organs liquify is a little bit more painful than a feeding tube.

Also, he had that feeding tube 18 years ago. Our medical technology and treatments have grown since then, reducing the discomfort.

Now, all that being said, it does sound as if the patient in question has mobility and some level of mental acuity, as shown in your statements that the caregiver believes the patient will remove his own feeding tube.

Is it not possible for the caregiver to feed the patient to ensure he receives the proper nutrition? What is the other issue going on that the patient is refusing food?

 

[DVIN_CKS]

Is it not possible for the caregiver to feed the patient to ensure he receives the proper nutrition? What is the other issue going on that the patient is refusing food?

Here’s the situation… patient is my father-in-law who has been living in a special home that cares only for Altzheimer’s patients. My mother-in-law is his medical advocate (I’ve been referring to her in this thread as his “caregiver”). She tries to visit him as often as possible during the week but it isn’t everyday. She relies on the the employees at this home to make sure that her husband is fed. However, these employees are not nurses and there hasn’t been a doctor “on call” for this house in months. If my FIL needs a feeding tube he will have to be transferred to a nursing home which my MIL doesn’t want to do. My husband and I are going to suggest that she try and make sure that his diet is supplemented with nutrient shakes like Ensure or Boost. I want to suggest that she sit down with a nutritionalist to discuss how to make changes to his diet in order to be maximizing his caloric intake. I believe her attitude though is “he’s dying” … “let’s just let nature take its course”. I sent her a link about the difference betw. extraordinary means and ordinary means of care but she doesn’t think that applies to her situation (she thinks that logic only applies if patient is in a “vegetative state”). She also says that she doesn’t want him to suffer anymore and that she doesn’t want to pro long his suffering with Altzheimers. She obviously doesn’t see the value in suffering (hers or her husband’s). I’m very frustrated because I don’t think she is thinking clearly and I don’t know how hard to push on this issue. UGH!!!

 

[Joe_5859]

Here’s the situation… patient is my father-in-law who has been living in a special home that cares only for Altzheimer’s patients. My mother-in-law is his medical advocate (I’ve been referring to her in this thread as his “caregiver”). She tries to visit him as often as possible during the week but it isn’t everyday. She relies on the the employees at this home to make sure that her husband is fed. However, these employees are not nurses and there hasn’t been a doctor “on call” for this house in months. If my FIL needs a feeding tube he will have to be transferred to a nursing home which my MIL doesn’t want to do. My husband and I are going to suggest that she try and make sure that his diet is supplemented with nutrient shakes like Ensure or Boost. I want to suggest that she sit down with a nutritionalist to discuss how to make changes to his diet in order to be maximizing his caloric intake. I believe her attitude though is “he’s dying” … “let’s just let nature take its course”. I sent her a link about the difference betw. extraordinary means and ordinary means of care but she doesn’t think that applies to her situation (she thinks that logic only applies if patient is in a “vegetative state”). She also says that she doesn’t want him to suffer anymore and that she doesn’t want to pro long his suffering with Altzheimers. She obviously doesn’t see the value in suffering (hers or her husband’s). I’m very frustrated because I don’t think she is thinking clearly and I don’t know how hard to push on this issue. UGH!!!

By the logic of “let’s just let nature take it’s course”, someone could say that about their infant child and let him or her starve to death (since babies can’t feed themselves, either). Would that be “natural”? Certainly not! Starving to death is not natural.

The reason the Church documents I previously referenced make special note of patients in a vegetative state is because that is where most people end up confused. If a patient is not in a permanent vegetative state, it seems all the more obvious that food is part of their ordinary care.

I know that working with family on situations like this can be very stressful. It seems like you’re doing everything you can (by talking to a priest and a nutritionist). You and your family are in my prayers!

 

[DVIN_CKS]

If a patient is not in a permanent vegetative state, it seems all the more obvious that food is part of their ordinary care.

EXACTLY!!! Why is this so hard to comprehend?

Even my husband was trying to differentiate between the fact that since his dad isn’t in a vegetative state that somehow we don’t need to apply the Church’s “strict standards” to his dad’s case. In fact he suggested I NOT send those Vatican documents to his mom. He seems to think that the “undue burden” clause could apply to his dad’s situation. I disagree.

Thanks for the prayers.

 

[hasikelee]

Here’s the situation… patient is my father-in-law who has been living in a special home that cares only for Altzheimer’s patients. My mother-in-law is his medical advocate (I’ve been referring to her in this thread as his “caregiver”). She tries to visit him as often as possible during the week but it isn’t everyday. She relies on the the employees at this home to make sure that her husband is fed. However, these employees are not nurses and there hasn’t been a doctor “on call” for this house in months. If my FIL needs a feeding tube he will have to be transferred to a nursing home which my MIL doesn’t want to do. My husband and I are going to suggest that she try and make sure that his diet is supplemented with nutrient shakes like Ensure or Boost. I want to suggest that she sit down with a nutritionalist to discuss how to make changes to his diet in order to be maximizing his caloric intake. I believe her attitude though is “he’s dying” … “let’s just let nature take its course”. I sent her a link about the difference betw. extraordinary means and ordinary means of care but she doesn’t think that applies to her situation (she thinks that logic only applies if patient is in a “vegetative state”). She also says that she doesn’t want him to suffer anymore and that she doesn’t want to pro long his suffering with Altzheimers. She obviously doesn’t see the value in suffering (hers or her husband’s). I’m very frustrated because I don’t think she is thinking clearly and I don’t know how hard to push on this issue. UGH!!!

Based on your update of the situation, it appears that the issue here is one of negligent care by his medical advocate, and not an issue of whether or not he should have a feeding tube inserted.

That being said, I am sure she doesn’t want to see her husband suffer. Watching someone suffer is an uncomfortable thing that no one wants to do. It would be easier on her to have him die quickly, so she wouldn’t have to experience that discomfort.

It sounds as if his caregiver has too much responsibility for being also the patient’s wife. These situations can be very difficult, both because of the emotions but also because she is not a licensed medical professional making knowledgeable choices.

I hope she seeks guidance for her and his sake.

 

[Eilish_Maura]

As his spouse and caregiver she may know more than she can even fully understand at this time.

In my own family there were times a spouse (and sometimes more family members) “knew” the end was near even when the person was not ‘actively dying’.

While it is very important for her to get good information and support it is vital that her decisions be respected.

 

[DVIN_CKS]

Well, my MIL was given the green light from her priest to refuse the feeding tube for my FIL. I’m a bit astounded but will not create waves here. Priest agreed that a feeding tube would be burdensome in FIL’s state of life but said that hydration was a MUST.

FIL I guess will slowing grow weaker and weaker due to malnutrition. He will be hydrated with an I-V, but that’s it. I assume he’ll suffer when his body begins to feel the affects of being denied basic nutrition. He’ll probably then be on heavy doses of morphine or other such pain killers. All of which will leave him in a comotose state until he dies (my guess).

Keep him and my MIL in your prayers.

 

[jmcrae]

Well, my MIL was given the green light from her priest to refuse the feeding tube for my FIL. I’m a bit astounded but will not create waves here. Priest agreed that a feeding tube would be burdensome in FIL’s state of life but said that hydration was a MUST.

FIL I guess will slowing grow weaker and weaker due to malnutrition. He will be hydrated with an I-V, but that’s it. I assume he’ll suffer when his body begins to feel the affects of being denied basic nutrition.

Is he actually being forbidden to eat at all? Or is he just not having the tube put in? There is a big difference, after all, and you mentioned before that he still has the ability to eat when he feels hungry.

By the way, my father isn’t eating very much any more, but he is still travelling and living his life. (He recently got back from Mexico.) I wouldn’t dream of tying him down to a hospital bed and putting a feeding tube into him. He can eat if he wants to, but I don’t see a need to force him. When he feels hungry, he will.

 

[SoCalRC]

The reason the Church documents I previously referenced make special note of patients in a vegetative state is because that is where most people end up confused. If a patient is not in a permanent vegetative state, it seems all the more obvious that food is part of their ordinary care.

It is important to keep in mind that the Church has designated the final moral arbitor in this case:

“Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.” - CCC 2278

The Congregation of the Doctrine of the Faith elabortated on this in its declaration regarding euthanasia:

vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19800505_euthanasia_en.html

"Today it is very important to protect, at the moment of death, both the dignity of the human person and the Christian concept of life, against a technological attitude that threatens to become an abuse. Thus some people speak of a “right to die,” which is an expression that does not mean the right to procure death either by one’s own hand or by means of someone else, as one pleases, but rather the right to die peacefully with human and Christian dignity. From this point of view, the use of therapeutic means can sometimes pose problems. In numerous cases, the complexity of the situation can be such as to cause doubts about the way ethical principles should be applied. In the final analysis, it pertains to the conscience either of the sick person, or of those qualified to speak in the sick person’s name, or of the doctors, to decide, in the light of moral obligations and of the various aspects of the case…

Therefore one cannot impose on anyone the obligation to have recourse to a technique which is already in use but which carries a risk or is burdensome. Such a refusal is not the equivalent of suicide; on the contrary, it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected, or a desire not to impose excessive expense on the family or the community. - When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted. In such circumstances the doctor has no reason to reproach himself with failing to help the person in danger.

In principle the Church does not consider nutrition and hydration extraordinary means, but it really does come down to a case by case basis. Depending on the patient’s personality and beliefs, and the exact medical circumstances, I could argue this particular situation either way.

My point, then, is that no matter how certain we each feel about the correct moral choices, we should have respect and compassion for those charged with heavy burden of making decisions on behalf of a loved one. I was placed in this situation with my father and it created a terrible strain between me and my siblings, all of whom had their own ideas of what should be done.

In other words, remember that even when we, ourselves, are morally certain, the people responsible may, in fact, have better insight into the patient’s wishes and beliefs, so we should strive to, ultimately be supportive and compassionate.

 

[rpp]

I am coming in a bit late on this but I think I can contribute something.

Several years ago, I had to have a nasal-gastric (NG) feeding tube inserted. While I was conscious and alert at the time, my ability to swallow had been temporarily paralyzed due to a surgical procedure on my esophagus. They are not painful or uncomfortable.

My father also had a feeding tube near the end of his life because he was having trouble breathing (because of diminished lung capacity) and that interfered with his ability to chew and swallow food. He was otherwise completely alert. He also had an NG type feeding tube inserted and did not complain of any discomfort.

NG type feeding tubes are not painful or uncomfortable. However, there are other types of feeding tubes as well and I cannot speak from experience on those.

HOWEVER, like nearly all medical treatments, not everything works for everybody. Some people tolerate it well others will not. Since I and my father were both conscious and alert, just unable to swallow we knew what was happening and could cooperate. Those with diminished mental capacity or cognitive deficits may not be able to cooperate in their treatment as willingly. Still others just cannot tolerate them for many reasons, psychological and physical.

Also, tubes going into and out of the body can be vectors for infection, though NG tubes are generally safe as the stomach does a better job and dealing with certain types of infectious agents.

 

[CB_Catholic]

I am coming in on this late, also. My Grandmother was in an advanced stage of Alzheimer’s at the age of 94 and gradually quit eating. She was also bedridden. My Mother and Aunt refused the feeding tube for her because they felt it cause more problems than benefits at her advanced age and advanced state of Alzheimer’s (which is a terminal disease). She had already pulled out catheters and IV’s and would have to be restrained with a feeding tube in place, either down her nose or directly into her stomach. And she was very adept at getting out of restraints, as many elderly are. She also had expressed to them before she became ill that she never wanted anything like a ventilator or feeding tube or CPR. I believe this was a moral decision on their part. The scenario that would have ensued had they allowed the feeding tube would have been less than dignified, for sure, and certainly not comfortable for her.

One cannot make the blanket statement that one should be provided with IV’s and fluids up to the end, because that can be harmful to a dying patient. If a person’s organs are shutting down, the kidneys will fail (and they fail earlier than the heart or lungs usually) and forcing fluids on them can cause pulmonary edema, which makes it very difficult to breathe, and heart failure. The person also blows up like a ballon with edema, and that edema can be painful, and cause their skin to tear. Also, when a person is in such a state, they do not necessarily suffer hunger pains. That is simply not true. That is why dying people often refuse food. The body does know how to die naturally, and as the toxins build up in the bloodstream from the failing kidneys, they will usually become comatose. I worked in an ICU for 19 years and watched this scenario almost daily.

This is terribly difficult on families, they want to do the right thing by their loved ones, but they are often misinformed or completely uniformed about these things. They also suffer a lot of guilt. And all too often, physicians tend to avoid discussing these things with them. And Ethics Committees often do not meet often enough to discuss these issues. At my Catholic hospital we do remove feeding tubes and discontinue IV fluids on terminally ill, dying patients if they are providing no benefit to the patient and are causing more suffering and the people responsible for the medical decisions agree. We do not do this on patients in a permanent vegetative state who are not in danger of death, however. That is a separate issue.

Each case should be evaluated thoroughly, and families should be entirely educated on the legal, moral, and medical issues involved. They should understand what happens when a person is dying–this does not have to be very technical. But we in the medical profession aren’t very good at this. If you are responsible for making such decisions, be sure to get informed. Ask questions. Know the positives and negatives, try not to function on emotions, which I know is very difficult to do. Also, try to know your loved one’s wishes on the matter. If you have elderly parents, try to get them to make a Living Will and appoint a Durable Power of Attorney for healthcare decisions. At least you’ll know their wishes on the matter before such situations arise.

 

[DVIN_CKS]

Is he actually being forbidden to eat at all? Or is he just not having the tube put in? There is a big difference, after all, and you mentioned before that he still has the ability to eat when he feels hungry.

He isn’t being “forbidden” to eat. He can eat small amounts of food himself but not enough to sustain his nutritional daily requirements. He can no longer drink fluids because he aspirates it, so fluids have to be thickened up for him. His mental capability to make coherrant decisions is far gone. He needs constant care. He cannot communicate verbally, is 90% deaf, can’t walk without help, is incontinent and very confused (doesn’t recognize family members). He is in the late stages of Alzheimer’s disease. I guess that he will eventually get to the point when he won’t be able to swallow (he’s not far from it right now).

The Church teaches that hydration and nutrition are “ordinary means” of care regardless of whether administered via artifical means or natural ones. The only exception would be if the patient can no longer assimilate (properly digest) the food or if the feeding tube causes an “undue burden”. I take that to mean an undue physical burden on the patient. If I’m wrong here, feel free to correct me. I agree with CB Catholic that once the body begins to die naturally, that a feeding tube is of no use (I watched this happen to my grandmother). My FIL is not in that category.

We will never know if a feeding tube inserted in my FIL’s stomach would be considered a physical burden since it was never tried to begin with. My MIL didn’t talk to the doctor about different feeding tube options. She is only familiar with the NG tube that her husband pulled out in the hospital. Who knows…maybe the stomach feeding tube would have been more comfortable and tolerable for him. Then again, maybe not.

My FIL is not on death’s doorstep at the moment. He gets up everyday and is helped to get dressed. He pretty much remains in a wheel chair since he isn’t too stable on his feet. He eats in the dining room of the Alzheimer’s house that he lives. We are not talking “deathbed” scenario here by any means. Although Hospice said that he will most likely die in 6 months or less. I’m not familiar with how long a person can go on minimal nutrition before their major organs begin to be affected? Does anyone have a guess?

 

[DVIN_CKS]

Those with diminished mental capacity or cognitive deficits may not be able to cooperate in their treatment as willingly.

Good point. My FIL would not be able to cooperate very well which is why the folks in the hospital had such a hard time getting the NG tube to remain in place. Not sure if the same would be true with a stomach feeding tube though.

 

[jmcrae]

My FIL is not on death’s doorstep at the moment. He gets up everyday and is helped to get dressed. He pretty much remains in a wheel chair since he isn’t too stable on his feet. He eats in the dining room of the Alzheimer’s house that he lives. We are not talking “deathbed” scenario here by any means. Although Hospice said that he will most likely die in 6 months or less. I’m not familiar with how long a person can go on minimal nutrition before their major organs begin to be affected? Does anyone have a guess?

My Dad is in a similar situation, although we thank God he has the use of his mind and can still get around on his own. He has been given until July or August; this is why he is jetting about from place to place - he wants to see this world that he’s about to be leaving.

They have given us the numbers, and they have told us that he will begin to decline rapidly when certain numbers reach certain levels. The interesting thing is that his number dropped by 200 points when he was in Mexico, meaning that he may have given himself an extra few months, at least.

 

[SoCalRC]

DVIN CKS;3366252T:

he Church teaches that hydration and nutrition are “ordinary means” of care regardless of whether administered via artifical means or natural ones. The only exception would be if the patient can no longer assimilate (properly digest) the food or if the feeding tube causes an “undue burden”. I take that to mean an undue physical burden on the patient. If I’m wrong here, feel free to correct me.

No, undue burden can be factors other than physical. See the quote from the Congregation of the Doctrine of the Faith I provided above.

Also, although it might seem like hair splitting, the Church does not teach that hydration and nutrition are, with only specific, outlined, exceptions, always “ordinary means”. The Church teaches that, as a general principle, nutriation and hydration are not extraordinary. We have to be careful not to overstate the teaching as an absolute, lest we put to much pressure on the people the Church has charged with the ultimate moral decisions.

 

[dalesmom]

As someone who puts NG tubes into patients, I can tell you it’s one of the most painful procedures that we do. You know how your nose hurts from just a bump. Imagine having a tube the width of a pencil shoved down your nose, throat, then stomach. The tissue often erodes and leaves terrible sores, not to mention the sore throat.
Patients don’t seem to complain about the feeding tubes as much, but they can be pulled out by confused patients. The bulb on the end is about the size of a small plum, so you can imagine the hole it leaves.
Since the priest approved witholding the feeding tube, why don’t you offer to help your MIL feed your FIL? I think it would give you a sense of contributing to his caloric and liquid intake. It would also help your MIL out alot.
Prayers for you all.

 

[mmch66]

I am a registered nurse and I can tell you that a nasogastric tube inserted through the nose into the stomach is very painful. A confused patient is also prone to pull it out requiring reinsertion. It can be anchored to the nasal septum to keep them from pulling it out. This causes even more pain.

A gastric tube inserted through the abdomen into the stomach is not so painful. It can be easily pulled out as well and must be reinserted in interventional radiology to ensure it is in the right place. Aspiration pneumonia can occur if the stomach is overfilled or the patient’s head is not elevated during and after feeding.

Death is a natural process that we will all go through unless we die suddenly. Sometimes these tubes are inserted to make the family feel better rather than providing any benefit to the patient. When a person’s kidneys and other organs begin to shut down they develop fluid overload if they continue to receive feedings or fluid which causes them to get fluid in their lungs and to develop tremendous swelling. They also are prone to develop diarrhea that causes the skin on their backside to break down painfully.

Starving a patient who is unable to eat and forcing food into a body that is shutting down are both wrong. The issue is whether the tube will harm him or add to his suffering. My grandmother had a tube in her abdomen because she could not swallow but was not dying. Depending on the patient’s physical state the feeding can actually harm them or shorten their life through the effects I described above.

+JMJ+

 

[DVIN_CKS]

Thanks for all the medical advice…I really needed to get that perspective in better focus.

I never believed that the NG tube was “the way to go”. The priest even mentioned that since the patient pulled it out on his own that we could take that as a sign from God that this wasn’t the way to go with him. If NG tubes are as uncomfortable as I’ve been lead to believe then I think my MIL made the right call not to have them try to reinsert it. However, I’m not sure she was open to discussing other artificial feeding options. I guess that is the part that troubles me. But I also realize that a feeding tube inserted in the stomach may not have been a good option either. At the end of the day, his medical needs may be best served letting nature takes its course. I’m okay with that.

I’m realizing that we all take different paths to get to the same conclusion. Whether I agree with the paths she has taken is irrelevant really. Would I have done things differently? Perhaps. I know I would have gotten more information on what would be involved in a stomach feeding tube and would have discussed the option at length with the doctor. I may have come to the same conclusion that ANY type of artificial feeding at this stage in his disease wouldn’t serve the intended purpose and only cause the patient mental anxiety and distress.

I agree that giving food to a body that is dying can cause more harm to the organs than good. In that case the food isn’t doing what it’s designed to do and it would be licit to stop feeding.

If a body can tolerate feeding and the food can be digested without causing serious problems to the body, then I think a good faith effort should be made to try and feed the person - whether artificially or naturally. It can become a fine line though and I respect my MIL’s free will to make the tough decision that I know she never wanted to make. I will support her and will do what I can to help ease the anxiety that she’s feeling in this difficult time. I bring my own anxieties and questions to this message board so that I can get objective opinions and information. It’s easier to come here because it’s not “emotional” like going and talking with the family (who are all very emotional and don’t use rational arguments).

Thanks again.