Terminating Tube Feeding in the Nursing Home: An Ethical Case Discussion
DOI: 10.3238/zfa.2018.0121-0124german translation / full article
Background: The health status of nursing home residents is usually characterized by old age, chronic multimorbidity, and resulting frailty. In this population, the goal and scope of medical therapeutic efforts as judged from the perspective of the person concerned is often not easy to determine. To support difficult decisions, ethics consultation services have been increasingly implemented also in the ambulatory care sector over the last years.Case Report: In a 85 year old resident with a long-standing history of psychiatric illness who refuses to eat and drink, continuation of artificial nutrition and hydration via PEG tube becomes controversial. As the patient’s wishes are difficult to determine due to the psychiatric illness, and since nursing home staff and family have diverging opinions about continuing the tube feeding, the goal of care is clarified within an ethical case discussion.Conclusions: In difficult situations, a moderated ethical case discussion can be helpful, leading to a decision that is not only as close as possible to the patient’s (presumed) wishes, but also acceptable for all parties and players involved in the process. However, early elicitation and documentation of the patient’s wishes, ideally facilitated by a qualified advance care planning process, remains the best available way to making patient-oriented decisions when decision-making capacity is unclear, limited or absent.