In 20 years, I’ve place over a hundred feeding tubes, primarily in elderly and demented individudals. In most of these cases, I serve as a technician. I am not consulted for my advice on whether a feeding tube is in a patient’s interest, but am asked to insert one after the decision has already been made. More than any other gastro procedure I perform, placing these tubes, called PEGs by physicians, is the most troubling. There is no question that gastroenterologists like me are placing more of these tubes than are medically necessary. Over the past few years, several medical papers have documented that providing tube nutrition for patients at the end of life, or with advanced dementia, provides no benefit. It does not prolong or improve life for many of these patients. Why, then, do we do it so often?
MICHAEL KIRSCH, M.D.
I am a full time practicing physician and writer. I write about the joys and challenges of medical practice including controversies in the doctor-patient relationship, medical ethics and measuring medical quality.
“Over the past few years, several medical papers have documented that providing tube nutrition for patients at the end of life,”
Thanks, Michael. I appreciate your comments and don’t disagree at all.
There is a lot of talking past each other on these threads having to do with “end of life”.
The peg (thanks for the medical jargon term) is of use in advanced age related dementia after aspiration becomes unavoidable when nutrients are take orally - in other words eating.
This happens well before, can be years, before any sort of end of life condition occurs. The feeding tube can allow Alzheimer’s patients to not die of pneumonia and live longer.