One of the social commitments of the physicians and medical practitioners is to prolong life and reduce suffering. Whenever the performance of the doctor’s duty is in conflict with the other, then it is always the preference and the decision of the patient and his family that will be followed. The principle of the patient autonomy had required the medical practitioners to respect the patient’s decision to forego or choose life-sustaining treatment of the patient especially those who still possess the capacity and potential of decision making (Shellito & Malr 180). The life-sustaining interventions refer to a treatment or an approach that is applied in order to extend life without repealing the fundamental medical condition (Thomas, Cummin & Falcone). The medical interventions that prolong life may include and is not limited to mechanical ventilation, renal dialysis, chemotherapy, utilization of antibiotics, application of artificial nutrition such as tube feeding and hydration.
In this paper, the medical intervention in sustaining life that is discussed and investigated is the tube feeding. Its ethical distinction, procedure, benefits as well as the process is thoroughly discussed. Moreover, reviews of companies and several journals about tube feeding are reviewed in order to assess the efficacy of the intervention and its competence in sustaining the life of the patients.
Why Use Tube Feeding?
Nutrition is one of the essential factors which sustains life and normal development of the person particularly among patients. Unfortunately, there are some illnesses like cancer that can prohibit the patient from eating good foods that they require. This is due to the medicine and other treatments that had caused the unpleasant taste of the food. Moreover, this treatment can also make the patient feel so sick that they don’t want to eat or simply feel that they are not hungry. In other cases the patient or child may also experience problems in swallowing or there are instances where in the throat is being irritated by the chemicals and the radiation as an after effect of the treatments (Spapen, et.al 301). Even after the treatment was done, and the medical workers had made their effort in making the patients particularly the child to eat, still there are cases when the patient is still unable to take in foods. Thus, the tube feeding is recommended in order to ensure proper nourishment of the patient and this could be a life saving intervention. Tube feeding is the safest way of providing nutrients to the patient especially to the child (Ishizaki, Hironaka & Tatsuno 208). Moreover, this intervention can be an effective way of helping the patient gain and recover the weight lost during the illness (Finucane, Thomas & Bynum). Providing food through tubes can also ensure stronger body for the patient and this can be a way of fighting against the complications of the illness.
What is tube feeding?
Tube feeding is commonly used among child patients. In this process, the food formula passes through the small tube which is connected directly to the digestive system of the patient (Segal, Michaud & Guimber 496). The formula is a liquid consisting of the necessary nutrients that the patient needs. The formula can be prepared with the assistance and guidance of the doctor, nurse or the dietician so that the appropriate nutrients will be given to the patient. Moreover, they are also responsible for making the decision of how long the patient will need to undergo the tube feeding. While there are patients that require tube feeding for several days, there are also patients who need to be tube-fed for the entire duration of the treatment or even longer (Thomas, Cummin & Falcone). Unless the medical practitioner will tell the patient otherwise, then the patient may take in regular meals.
How to place the tube?
The positioning of the tube inside the patient’s digestive system depends on several factors. Spapen, et. al (302) cited that these factors may include: a) the duration of the tube feeding; b) the health of the patient’s digestive system and the proper functioning of its parts; and c) the potential risk of the side effects that the tube feeding may cause. Indeed, the placement of the tube in the body is quite simple and painless. The doctor may use one of the five common processes of connecting the tube either in the stomach or the small intestine of the patient. One process is by letting the nasogastric tube (NG tube) to pass through the nose then down to the throat and the stomach. Another way is with the utilization of a nasojejunal tube (NJ tube) that passes through the nose, down to the esophagus to the stomach and directly to the small intestine. The third method is inserting the gastrotonomy tube (G tube) in a minute skin cut and directly connecting it to the stomach (Segal, Mulchaud & Guimber 496). A gastroenteric or transgastric jejunal tube (GJ tube) on the other hand can be inserted in a skin cut and letting it passes through the stomach then to the small intestine (Finucane, Thomas & Bynum). Whenever the tube is in its proper position, the patient may need one or two days for coping and adjusting to the condition. Then the patient especially the child may become adept to the tube and then the feeding of formula can be started as soon as the tubes are already secured in its place.
Kind of formula for tube feeding
When it comes to the kind of formula that can be used, the doctor or dietician may take into consideration the condition and the age of the patient (Ishizaki, et.al 211). Experts have emphasized the proper dose of the formula on appropriate times which can be helpful in providing the child or the patient with proper nutrients necessary for growth, cell repair and fast recovery and healing (Thomas, et.al). In the course of the tube feeding, the medical staff may change the amount and the type of the formula depending on the patient’s reaction and changes in the condition.
Generally, there are two types of tube feeding formula that are used. It can be bolus feeding or continuous feeding (Shellito & Malr 182). The bolus feeding is given to the patient using large doses of the formula several times daily. This is patterned on the way normal people take their meals daily. The formula can be inserted through the tube using a pump or through a syringe (Ishizaki, et.al 209). The continuous feeding on the other hand, utilized a syringe in order to steadily pumped small drips of formula into the tube for a longer period of time (usually 12 to 24 hours) (Thomas, et. al). The feeding methods may be changed by the hospital staff depending on the improvement on the condition of the patient. Moreover, a change in the lifestyle of the patient may also be recommended in order to meet the patient’s needs and health requirement.
Related Studies on the Effectiveness of Tube Feeding
When it comes to the effectiveness of tube feeding several studies have been conducted. Shellito & Malt conducted an assessment on the safety of the nasogastric tube for prolonged gastrointestinal decompression. It was found out on this study that it is expected in tube feeding using the gastrostomies to have internal leak as compared with the decompression gastrostomies. Moreover, the low complication rate can be justified using the gastrostomies being a substitute for extended nasogastric intubation (Shilleto & Malt 185). It was also proven in this study that the complications caused by tube feeding can be minimized using the Stamm technique with straight catheter and anterior gastropexy (Shilleto & Malt 185).
Spapen, et.al on the other hand conducted a study on the condition of enteral feeding to control the nutrition associated with diarrhea using fiber-rich food formula. Moreover, the researchers investigated on the impact of this method of tube feeding on the patient’s stool production especially among those who are diagnosed to have severe sepsis which shows greater risk of the development of diarrhea. It was found out in this study that the tube feeding which is supplemented with soluble fiber is advantageous in the reduction of diarrhea among patients which are tube fed and mechanically ventilated (Spapen, et.al 305).
Finucane & Bynum also conducted another study on the benefits of tube feeding in preventing aspiration pneumonia. It was found out that it is common among tube feeding patients to experience aspiration as one of its complications. Thus it is recommended by the researchers that tube feeding should be monitored closely in order to lessen and minimize the complications of tube feeding.
Possible Effects of Tube Feeding
Just like any medication, tube feeding has also its limitation and side effects. On the course of its application, side effects may occur however most of them can be prevented by using and choosing the appropriate formulation and kind of food formula and giving it in a proper way.
Some side effects may occur with tube feeding, but most can be prevented by choosing the correct formula and by giving it properly. Thus, it is necessary that the person administering the tube feeding will strictly follow the instructions. In case of any observed problems on the patient’s condition and in the tube-feeding process, then the doctor should be informed immediately. Among the common side effects of tube feeding include experiencing loose bowel movements, bloating, nausea and vomiting (Spapen, et.al 303). In addition, there are also more adverse impact of tube feeding that requires immediate attention from the doctors and health practitioners. It is common among patients undergoing tube feeding to have experience the movement of the tube from its position (Shellito & Malt 185). There are also cases wherein the formula gets into the lungs of the patient which eventually trigger serious complications (Segal, et.al 497). Lastly, infection or irritation may also occur in the area where the tube is placed. Hence, it is necessary that the medical staff will regularly check on the condition of the patient and on the process of tube feeding in order to see any problems and in order to evaluate the condition of the patient and how it has reacted to the process of tube feeding.
When it comes to sustaining life of the patient, there is no ethical distinction between retreating or withholding treatments that prolonged life. For the case of competent adult patient he may formulate a valid consent for acquiring the life-support system however for patient who is already incompetent of making such decision, a surrogate decision maker may represent in deciding as to what intervention to take in sustaining life or in withholding the medical interventions. Indeed, there are several medical interventions that can prolong life that the patient or his family can choose from. However, this intervention should be applied based on the consideration on the condition, capabilities and needs of the patient. Moreover, it is also necessary that the patient as well as his family understands that life support interventions like tube feeding only sustains life and do not provide assurance of curing the illness. In order to make tube feeding more effective and efficient in providing proper nutrition to the patient, it is further necessary that proper administration is observed, appropriate food formula that fits to the dietary needs of the patient is given and there should be regular monitoring of the process so that its adverse effects and complications can be avoided.