Christian Worldview Concepts

Feeding Tubes and End-of-Life Decision Making

When May We Stop Use of a Feeding Tube?

Advanced disease or a degenerating chronic condition, including the complications of advanced aging, can diminish one's appetite or render one unable to assimilate the benefits of food and fluids. At some point, a person may lose the ability to swallow, which may be an additional symptom of a terminal condition. Do these conditions, which may occur separately or concurrently, constitute a medical emergency requiring intervention or should they be viewed as the normal progression of a person's deteriorating health and impending death?

When a person is clearly dying and providing food and fluids would make matters worse for the patient, it is hard to see how the sanctity of human life principle would require tube feeding. When there are overwhelming conditions that indicate the person will die with or without intervention, it can hardly be said that their death is intended if a feeding tube is withdrawn or withheld. The following criteria might be helpful in making decisions about feeding tubes. Feeding tubes are an appropriate form of comfort care and should be used unless:

1. The patient's condition makes it impossible to provide food and fluids.
2. The patient's death is deemed to be imminent — within hours or days.
3. The patient cannot physically benefit from food and/or fluids.
4. The patient's discomfort and/or pain would be exacerbated by providing food and fluids.
5. The patient verbally or physically rejects food and fluids, or there exists clear and convincing evidence that he or she would not want them

For those patients that are unconscious or incapable of communicating their wishes, we should presume that the provision of food and fluids is in their best interests. Their provision should be seen as customary comfort care.