...Mortality, February 2005; 10(1): 69 – 81 Tube feeding: Prolonging life or death in vulnerable populations? ELAINE J. AMELLA, JAMES F. LAWRENCE, & SUZANNE O. GRESLE Medical University of South Carolina, Charleston, SC, USA Abstract Tube feeding can be an appropriate and effective means of providing nutrition for individuals who are unable to achieve adequate nourishment orally because of various medical problems. However, the delivery of nutrients by tube feeding can cause ethical dilemmas in cases where the effectiveness of tube feeding diminishes and medical complications increase. The decision to tube feed is often influenced by regional and cultural preferences, as well as the high cost of providing mealtime assistance. The effectiveness and appropriateness of tube feeding has been the subject of much debate as it applies to those with severe cognitive impairments and those who are in a persistent vegetative state (PVS). Recent research shows that in these vulnerable populations, tube feeding alone does not necessarily prevent malnutrition and risk of infection or improve functional status and comfort. While advanced directives allow an individual to make decisions about his or her care at the end of life, court cases and religious doctrine examine the individual’s right to autonomous decision making in opposition to preserving the sanctity of life. As long as the outcome of this debate is largely undecided, the process of dying may be prolonged for...
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...On February 25, 1990 began the life and death struggle between spouse and family to determine the fate Terri Schiavo’s life. Schiavo suffered from an episode of cardiac arrest which left her unconscious and without oxygen to her brain. Resuscitation efforts were a success but due to the lack of oxygen there was irreversible damage done to her brain. Once placed into the hospital, Schiavo needed an aggressive form of care and was ultimately intubated in order to help her breathe. It was later determined that she was would most likely spend the rest of her life as a vegetable, it was then that the struggle between her spouse and family would ensue. Once it was determined that there was no hope of a full recovery, Schiavo’s husband made it clear that his wife would not want to live on life support and wanted to have her feeding tube removed. “Schaivo’s husband and legal guardian argued that Schiavo would not have wanted prolonged artificial life support without the prospect of recovery, and elected to remove her feeding tube.” Once Michael, Schiavo’s husband, elected to have the feeding tube removed, her family began the process of trying to keep her alive. “Schiavo’s parents argued in favor of continuing...
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...of Bouvia vs the Supreme Court, is the case in which Bouvia, a patient at a public hospital, wanted a feeding tube removed that was placed in her against her will. In this essay I will give a brief overview of the case, then I will relate the relevance of a couple ethical terms. Thirdly, I will discuss how an act-utilitarian would approach this case and finally, I will give my opinion of this case. The hospital in which Bouvia was in put in, in an effort to get food into her system. Bouvia, who is a quadriplegic and has since birth suffered from a severe case of cerebral palsy, did not want it in because it was very uncomfortable and she didn't want to take measures to prolong her life. Because of the cerebral...
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...lack of oxygen in her brain. Terri had brain damage and was in a vegetative state “ during the subsequent months, she exhibited no evidence of higher cortical function. Computed tomographic scans of her brain eventually showed severe atrophy of her cerebral hemispheres, and her electroencephalograms were flat, indicating no functional activity of the cerebral cortex. Her neurologic examinations were indicative of a persistent vegetative state, which includes periods of wakefulness alternating with sleep, some reflexive responses to light and noise, and some basic gag and swallowing responses, but no signs of emotion, willful activity, or cognition” (Quill, M.D., 2005) At the hospital to buy time and keep her alive doctors had inserted a feeding tube. Two months later, her husband Michael transferred Terri from the hospital to a rehabilitation center. The following month her husband with no objections from her parents became her legal guardian. Her parents tried taking her home and caring for her but later sent her back to the rehab center because it was too much work to take care of her at home. Terri needed round the clock care “For months 13-18 into her coma, three shift of workers worked 24 hours a day trying to rehabilitate Terri” (Pence, 2011) For five years, Terri received intensive rehabilitation efforts to try to get her to regain consciences. Michael in the meantime received money from the malpractice suit brought against the obstetrician who failed to diagnose...
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...great financial burden on the Medicare system as well as patient’s families. Atul Gawande (2010) reports that twenty five percent of all Medicare spending is for the five percent of patients who are in their final year of life, and most of that money goes for care in their last couple of months, which is of little apparent benefit (p. 3). Even more concerning is the suffering that many patients are forced to endure due to the lack of other options. Patients must have the right to make autonomous decisions regarding the end of their lives. They need to be confident that those decisions will be upheld, even if they conflict with the wishes of their families or physicians. However, patient confidence in knowing that their final wishes will be met is complicated by a lack of education and empowerment for those who face these difficult decisions (Frank & Anselmi, 2011). The purpose of this essay is to discuss the benefits to patient autonomy and the Medicare budget, by the legalization of physician-assisted suicide and voluntary euthanasia. Legalizing Euthanasia: A Practical Approach Imagine that your beloved pet suffered a stroke and could no longer eat, drink, walk, or care for itself the way it had been able to do previously. Would you have a feeding tube inserted into him and care for his every personal need? The answer to this question may seem obvious when discussing a pet, but what...
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...Debate Paper Katherine Lund XBCOM275 October 13, 2013 Tynia Landry Debate Paper Imagine being terminally ill and in an insufferable amount of pain; would you prefer to suffer or permanently relieve the pain? Until 1999, a man by the name of Jacob “Jack” Kevorkian offered assistance to people who wished to end their own life with a physician assisted suicide also known as Euthanasia. The term Euthanasia was first used in the 17th century as a medical term to describe an easy, painless, and happy death. There are two types of Euthanasia, passive and active. Passive euthanasia is when a patient refuses their medical treatment which may hasten their passing; this is also considered legal euthanasia. Active euthanasia is the acceleration of death by the use of drugs and it can be either physician assisted or done by the patient themselves and is also considered illegal euthanasia. While active euthanasia is illegal in most of the United States as well as the world, there is controversy that it should be the terminally ill patient’s choice as to whether or not they live in pain or suffer. How can helping someone relieve pain and suffering be illegal? The ethics of euthanasia have been a debate since the 1800’s, with debates peaking every couple of decades. Many of the debates against euthanasia fall back to the ethics and how euthanasia can be used as a solution to lower medical costs, a failure to provide care for people with disabilities, or even that the doctor...
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...as having sustained probable cerebral contusions compounded by significant anoxia (lack of oxygen). Nancy Cruzan was deprived of oxygen from 12 to 14 minutes. She was declared to be in a “persistent vegetative state”, meaning that she had all her motor reflexes, but no significant cognitive functions. The parents of Nancy Cruzan had asked the hospital to remove the feeding and hydration tubes from their daughter, the hospital refused without a court approval. Procedural History: Authorization to disconnect the feeding and hydration tube was given by a state trial court which found “that a person in Nancy's condition had a fundamental right under the State and Federal Constitutions to refuse or direct the withdrawal of death prolonging procedures.” The state trial court also used a conversation that Nancy Cruzan had with a friend at the age of twenty-five. She had mentioned to her friend that she would not want her life to be sustained artificially unless she could live a halfway normal life. The case was then appealed to The Missouri Supreme Court which reversed the order to allow termination of the life-support, because convincing evidence was not produced that demonstrated that Nancy Cruzan would have refused treatment if she would have been able to make that decision. Issues: Does a person in a “vegetative state” have the same constitutional right to refuse treatment as someone who is able bodied? Does Missouri’s...
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...Comparison of Cruzan and Schaivo Cruzan o The family all agreed to discontinue the g-tube feedings on Cruzan who suffered permanent brain damage, but the state intervened and kept Cruzan alive because there was no clear and convincing evidence of the intent to refuse care. The state ruled that they had an interest in Cruzan’s life. o Principles established the right to refuse medical treatment is a liberty interest under the 14th Amendment The state has a valid interest in protecting all life A justification for a high standard of proof in evaluating the actually intention of a persistently vegetative patient. • Cruzan used Addington precedent which established clear and convincing evidence as a constitutional minimum for decisions to discontinue nutrition and hydration. Belmont Report principles (principles of bioethics ) o Beneficence –requires that the varied risks and benefits of an intervention be weighed.; the duty to do good o Non Maleficence- duty to do no harm o Autonomy -patients are able to exercise free will and free decisions o Justice- Freedom from discrimination; fairness in distribution of medical resources Medical Futility- o The concept that medical care should be deemed futile was one of the 3 fundamental principles that Hippocrates declared for the practice of medicine: to cure, relieve suffering and refuse to treat “those who are overmastered by their disease. o The AMA Code of ethics provides that the decisions should not be...
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...where we face our own mortality. For many this is very scary, and often avoid planning and preparing for their impending death. Everyone has their own views, opinions and preferences as to how they wish their impending death to be handled. There are a variety of legal documents one can execute to assist medical professionals and family in carrying out ones wishes. However, many do not want life prolonging measures utilized at their time of death. A life prolonging procedure is a treatment, procedure, or intervention that uses mechanical or artificial means to restore, sustain, or replace a bodily function that without the person’s life would cease. Susan Herskowitz, Wills, Trusts, and Estate Administration 146 (4th e.d. 2014) This becomes an issue of controversy as many view making these kinds of designations and choosing how you want your life ending time to occur. So many ask do we have a right to die. Should we be allowed to choose our life ending measures? Some would argue no, one does not have the right to choose their life ending measures, while others argue yes, you should as it is your life, and you are the keeper of it. Where this become an issue is when you are facing death, often times you aren’t able to make such decisions, therefore, they are left to that of family and medical professionals. We shall also look at this right from a biblical perspective. The last enemy that shall be destroyed is death. For he hath put all things under his feet, but when he saith all things...
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...June 16, 2014 We are hearing all too frequently about End of life issues and decisions that family members are having to deal with because of not being prepared for when the time comes for a loved one. I will discuss more in depth the issues, problems and solutions to making this seemingly painful and undiscussed topic something that will help make it less painful and more important to do before the time comes. Death is something that is inevitable, it will eventually come to us all, some sooner than later and we should do all that we can to make it less stressful and painful to the loved ones we leave behind. Making these End of Life choices beforehand has always been considered a “taboo” of sorts because it’s just an issue that is never discussed. There is no said population that this matter should be discussed with because no one knows when they are going to die unless they are contemplating suicide and that’s an entirely different situation. End of life choices is a role that many of us may have to step into whether for ourselves or assisting our loved ones with them. “Only about one in four people have signed advanced directives that spell out their wishes if they’re unable to make medical decisions on their own, according to a 2006 report published by the Pew Research Center for the People & the Press”. An advance directive includes two types of documents, a living will describes what sort of life-sustaining and other treatment people want if they’re unable...
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...On January 11, 1983 Nancy Cruzan was involved in a car accident that left her in a continued vegetative state. In order to feed her and to speed up the recovery, surgeons implnated a gastronomy feeding and hydration tube in Cruzan with her husbands consent. It became apparent that Cruzan had no chance for recovery, her parents ask hospital employees to discontinue artificial nutritions and hydration procedures. This removal would cause her death. The employees refused to honor this request without court approval. The Missouri Supreme Court claimed a person in Nancy’s condition had a constitutional right to refuse or direct the withdrawal of “death prolonging procedures”. They refused this request because there was no clear and convincing evidene...
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...Advance Directives are our wishes when we are at end of life stages of life that give specific direction of how, who, and when to treat us in our final days and hours. We can have documents drawn up to say what we want in the event we are in a state where we cannot voice our wishes aloud. These documents have legal and ethical basis, and they should be followed unless the legally or ethically unable to do so. Advance Directives gives a documented guide to the care giver’s or family member’s, so that they all can provide the kind of care that the medically impaired patient wants. This covers a wide variety of medical treatments such as dialisis, ventilators, feeding tubes and organ and or tissue transplants. If a patient has kidney failure they might or might not want to be on dialysis. The advance directive would spell out whether the patient would want such treatment if he or she was not able to convey this to the medical personnel. If the patient was at the end of life and did not want to be kept alive via artificial means such as a ventilator of feeding tube, the advance directive would have the patients wants of this type of treatment also. If the patient passed away and wanted his or her organs donated, then this directed would defanitely give the right to have their organs harvested and donated to someone in need. Even though there might be an advanced directed for a patient that is not able to express their wishes to their family or care givers, there can still...
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...death and illness on a daily basis requires self-examination and a high degree of comfort with one’s own mortality, limits and values. Constant exposure to the fragility of life forces respect for the whole person and the people who love them. A general approach to patients who are actively dying is to allow them to define what they want and need during this time. The nurse’s role is to support what is important to the individual. Nursing care is tailored to support patient defined goals. The person who is actually experiencing the journey should be the one who defines suffering, and how their limited time will be spent. Nursing can teach both the patient and the practioner that knowing the end of life is coming can be a great blessing. This knowing that time is limited can allow healing and reconciliation not possible at any other time in a person’s life. The death of a loved one is not just about the loss of the individual, it is also about one’s own mortality. Nothing else can force surrender and acceptance like the illness and death of a close family member. B. Strategies to Improve Quality of life for Mr. and Mrs. Thomas 1. Help the couple define the source of their depression. Unspoken concerns and fears about death can be a source of depression. Death is a natural part of life. Facilitation of open discussion about Mrs. Thomas’s condition and her prognosis should be explored. Defining what her illness and eventual death means for each of them encourages...
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...treatment intervention. End-of-life care in the ICU concerns both ‘normal’ dying process with aggressive pain management and the decision to end life with an “A good death”. “A good death” is a person dies on his own terms, relatively free from pain, in a supported medical setting. The medical team plays big roles in both processes. Koesel and Link state that, “At times, ongoing aggressive life-prolonging interventions for a terminally ill patient can create ethical conflicts and moral distress for nurses” (1). Nurses have an ethical obligation to the patients which conflict with the patient’s choice...
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...Phil 160 10/8/2008 Euthanasia Film Report: Million Dollar Baby The Million Dollar Baby movie focuses around a young lady named Maggie and a amateur boxing trainer. The whole movie is based around the career of both characters, and the issue of euthanasia comes into play during the last part of the movie. Another opponent illegally hits the boxer, Maggie, and Maggie then hits her head on the stool, and subsequently, she is paralyzed from the neck down. The issues of euthanasia becomes an issue when Maggie gets tired of being in a vegetative state after the productive life she had been living as a boxer. Dunn her trainer gets into a conversation with Maggie, this turns into an issue of whether or not she wanted to live beyond her natural life. She argued that she was only alive because of the respirators, and that she had lived life to the fullest already. Dunn, a Catholic, disagrees with actively or passively letting her die. In all, his faith is conflicted with his understanding of the pain she was going through. He was empathetic with her state of quadriplegia. She was discontented but could not kill herself, so she tried to bite her tongue as a way to bleed herself to death. Many topics discussed in class about euthanasia were brought up in the movie. For example, did Maggie have a personhood while in her state, or would helping Maggie die faster would that be active or passive? Dunn, finally unplugs Maggie’s respirator, and injects a lot of adrenaline into her arms...
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