Sunday, January 31, 2010
Can tube feeding save grandma's life?
Experts generally agree that tube feeding is a good idea in certain medical situations. However, when patients have advanced dementia, studies have not shown that tube feeding improves the length of life or quality of life. So tube feeding, while it may seem like a good solution, may not make grandma live longer. In some cases, tube feeding can result in negative consequences that can actually result in harm...things like infection around the tube site or intolerance of feeding that causes nausea, vomiting, or diarhea. Patients that are tube fed may also be more likely to get aspiration pneumonia, a condition that is a result of food or fluids going into the lungs rather than down the esophagus and into the stomach. Tube feeding is not just considered nutrition, it is considered a medical intervention, like other medical interventions such as dialysis or use of a ventilator for breathing. Placment of a feeding tube requires minor surgery and transportation to a hospital or clinic, which can be difficult and traumatic for some elderly and/or confused patients. These are all issues that should be considered when a family is making a decision "to feed or not to feed".
Sunday, January 24, 2010
Should we pull the plug on Grandma?
I am happy to be back to blogging and hope to post more frequently in the weeks and months to come.
Recently our county has been having a national debate on health care reform. During this conversation, pundits and politicians alike have accused the government of wanting to establish "death panels" that will make decisions about "pulling the plug on grandma" to save costs. Obviously this is a complex and difficult issue that has been oversimpified in the media. There are many, many facets to this conversation and I plan to address several of them in the weeks to come. However, when I look at how families make end-of-life decisions, my first question it: Is saving grandma in her best interests? Or do you want to save grandma for your sake, not hers?
In my experience, many elderly and ill patients are tired and uncomfortable and are ready to pass on "to a better place". Sometimes family members (who are usually health care power of attorney) believe that everything should be done to prevent grandma's death and save her life, despite what grandma says. Lifesaving interventions might include hospitalization, medications, IV fluids, or tube feeding(which usually requires minor surgery). I contend that in many cases when family members make decisions to safe a life, they are making them for selfish reasons, not for the sake of grandma. Perhaps they cannot imagine life without grandma. Maybe they cannot handle the guilt of making the decision not to save grandma's life. Whatever the reason, I can't help but wonder whether letting grandma die a peaceful and natural death is more humane than making her endure uncomfortable or painful procedures to sustain her life for a few days, weeks, or months. Which brings back the question..why are we saving grandma? Is saving grandma in her best interests? Or do you want to save grandma for your sake, not hers?
Recently our county has been having a national debate on health care reform. During this conversation, pundits and politicians alike have accused the government of wanting to establish "death panels" that will make decisions about "pulling the plug on grandma" to save costs. Obviously this is a complex and difficult issue that has been oversimpified in the media. There are many, many facets to this conversation and I plan to address several of them in the weeks to come. However, when I look at how families make end-of-life decisions, my first question it: Is saving grandma in her best interests? Or do you want to save grandma for your sake, not hers?
In my experience, many elderly and ill patients are tired and uncomfortable and are ready to pass on "to a better place". Sometimes family members (who are usually health care power of attorney) believe that everything should be done to prevent grandma's death and save her life, despite what grandma says. Lifesaving interventions might include hospitalization, medications, IV fluids, or tube feeding(which usually requires minor surgery). I contend that in many cases when family members make decisions to safe a life, they are making them for selfish reasons, not for the sake of grandma. Perhaps they cannot imagine life without grandma. Maybe they cannot handle the guilt of making the decision not to save grandma's life. Whatever the reason, I can't help but wonder whether letting grandma die a peaceful and natural death is more humane than making her endure uncomfortable or painful procedures to sustain her life for a few days, weeks, or months. Which brings back the question..why are we saving grandma? Is saving grandma in her best interests? Or do you want to save grandma for your sake, not hers?
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