Feeding tubes questioned

PHOTO: Feeding tubes questioned

The Japan Geriatrics Society has come up with the view that medical facilities should consider as an option the suspension or infrequent use of a medical procedure in which a surgical incision is made in the stomach of aged terminally ill patients and a feeding tube inserted.

Health care professionals and patients' families are facing the difficult decision over how terminally ill patients can die with dignity.

"I don't know whether it was right to give him this kind of treatment," a 74-year-old woman from Saitama Prefecture said, describing her feelings whenever she visits her husband in the hospital.

Her 78-year-old husband, who was diagnosed with dementia about four years ago, gradually stopped eating. He was hospitalized two years ago.

When the doctor offered to use the procedure, known as percutaneous endoscopic gastrostomy, she agreed after being told he would wither away and die without it.

She said her husband was a sociable man who was active in community matters.

As he is bedridden, unable to express an opinion and kept alive through the nutrition supplied by a feeding tube, she wonders whether he is happy now or really wants to go on living.

Whether the procedure should be used after a patient is unable to eat anything is a major challenge doctors and patients' families face in providing terminal care for aged patients.

Late last month, for the first time in 10 years, the geriatrics society revised its position on medical and other treatment for aged patients at the end of life.

The society now says, "The suspension or lesser use of such methods as percutaneous endoscopic gastrostomy and artificial respirators need to be reconsidered as options when such treatments could undermine the dignity or increase the pain of patients."

Tsukuba University Prof. Setsu Iijima, an ethics committee chief of the society, said the revision was made as there has been an increase in people refusing the treatment.

"Ten years ago, this view would be considered premature, but knowledge of the treatment has spread among the general public and the number of those who reject it [for themselves or patients] are increasing," he said.

Since the procedure is effective in providing nutrition, some patients recover their physical strength and start eating normally.

But the widespread use of the procedure indicates that in many cases medical institutions use the method not only for medical reasons, but also from a business standpoint. Some institutions are believed to use the procedure to move patients, who still are not fully able to eat normally, to other facilities as quickly as possible to shorten their hospital stay.

Nursing care facilities also may persuade residents to accept this procedure because it saves time and effort in helping them eat and avoids swallowing problems.

Akihiko Ito, deputy director of gastroenterological medicine section at Kusatsu General Hospital in Kusatsu, Shiga Prefecture, said it is extremely difficult to end the treatment once it has started, even when the treatment begins losing its effect.

"A decision should be made after confirming whether the treatment will be effective," Ito said.

Reiko Miyamoto, head of the center supporting dementia patients at Sakuradai Kojinkai Hospital in Sapporo, welcomes the medical society's revision, as the dignity of patients is undermined in many cases because this type of terminal care is provided against their will.

However, other people are worried about suspending necessary medical care for the elderly.

"When patients and their families do not want to procedure carried out, their will should be respected," said Masatoshi Yokouchi, the director of Izumi Clinic in Hamura, Tokyo. "But the idea that this treatment should not be provided for dementia patients cannot be tolerated, as that might be construed as a move to curb the nation's medical costs."