Tubes used less in US, Europe

PHOTO: Tubes used less in US, Europe

Negative views have become prevalent in the United States and Europe over the use of feeding tubes inserted through an abdominal incision in terminal dementia patients, based on advanced research on the procedure, according to Kaoruko Aita, a special-appointment researcher at the University of Tokyo.

The US-based Alzheimer's Association said in its guidelines there is no medical evidence to show the procedure benefits patients who cannot swallow food due to advanced Alzheimer's disease.

The European Society for Clinical Nutrition and Metabolism argues there is no medical evidence the procedure reduces the occurrence of aspiration pneumonia or bedsores, improving patients' quality of life.

Aita said, "Like terminal cancer patients, terminal dementia patients feel less pain when they are given little water and nourishment."

"In the United Sates, it's accepted that an artificial nutrient supply has no effect on terminal dementia patients," Aita added. She added, however, that some care facilities use the procedure.

The Japanese Health, Labor and Welfare Ministry decided in 2007 on guidelines to determine treatment for terminal patients. The move came following the deaths of terminal cancer patients at a hospital in Toyama Prefecture after doctors removed them from artificial respirators.

According to the guideline, when it is possible to confirm a patient's intention, their medical care service team will decide on treatment based on the patient's wishes.

When it is not possible to confirm a patient's intention, the medical care service team will choose the best possible treatment for the patient after discussing the matter with the patient's family.

The ministry's guideline acknowledges the choice of ending life-prolonging treatment after undergoing the appropriate procedures. But it does not cover the details of life-prolonging measures, concrete procedures to stop such treatment and exempting doctors from liability.

Many doctors therefore complain about the guideline, saying, "It's impractical" and "It fails to eliminate our concerns over possible lawsuits for ending life-prolonging treatment."

Meanwhile, the Japanese Association for Acute Medicine and the Japan Medical Association also set up their guidelines on terminal medical care in 2007.

The Japanese Association for Acute Medicine's guideline specifically defined the terminal stage, which the health ministry did not do.

As for measures to stop life-prolonging treatment, the association's guideline calls for stopping the use of artificial respirators, stopping dialysis and stopping or reducing water and nutrient supplies.