SHOULD A TUBE FEEDING BE ADMINISTERED TO PERSONS WITH ADVANCED STAGE OF ALZHEIMER’S DISEASE?

 

There was a young woman who had a dilemma whether to place her mother who had an advanced stage of Alzheimer’s disease (dementia) on a tube feeding. She had stopped eating. She had an advance directive indicating that she did not want to recourse on tube feeding to sustain her life.  The daughter asked, should we recourse to tube feeding to sustain my mother’s life?  Is it a moral issue to stop giving her tube feeding? What is the Church’s position on removing tube feedings for patients who are in the advanced stage of their illness?

The Catholic Church “supports advance directives, provided these are executed in a way that is consistent with Church teachings.”[1] The considerations of providing feeding tubes to patients who are in the state of coma or persistent vegetative state are very different from the considerations of using tube feedings tubes to patients who are in the advanced stage of progressive diseases such as cancer, Parkinson’s disease AIDS, and Alzheimer’s disease, among others. The administration of tube feedings in these types of patients will often result in great burden and other complications.[2]

There is a consensus among medical societies that show the burdens of introducing tube feedings to this population.  Some of the cited burdens associated with tube feeding on advanced dementia include the following:

  A) medical-surgical interventions required to place the feeding tube; B) the potential for    infection at the incision site, leading to the possible need for antibiotics and for hospitalization; C) the discomfort experienced from tube feeding, and D) the likelihood of requiring physical or chemical restraint to prevent tube pull out (as some patients may pull it out repeatedly because of irritation).[3]

There are instances that patients need to be restrained to be fed.  According to Dr. Sulmasy, “In these conditions, it has even been difficult to show that the use of feeding tubes makes the patients live longer.”  Dr. Sulmasy concluded, “Clearly, in many such cases (advanced stage of Alzheimer’s), the burdens of treatment can be judged disproportionate with respect to the benefits, and the treatment could, therefore, be judged extraordinary or morally optional.” [4]

Fr. Tadeusz Pacholczyk, a consultant of the National Catholic Bioethics Center upholds that we must carefully weigh whether such a tube would indeed be proportionate to patient’s health in advanced dementia at a point close to death.  Fr. Pacholsczyk maintains that “our desire to comfort and palliate those suffering from an end-stage disease is an important part of the equation in mapping out the best options for healthcare treatment.”[5]

__________________________________________________________

[1] Daniel Sulmasy, Are Tube Feedings Morally Obligatory?, available at https://www.franciscanmedia.org/are-feeding-tubes-morally-obligatory/

[2] Daniel Sulmasy, Are Tube Feedings Morally Obligatory?

[3] Berlinger, Jennings and Wolf,  The Hastings Center Guidelines, 171-174.

[4]  Daniel Sulmasy, Voluntary Stopping Eating and Drinking, 2014.

[5] Rev. Tadeusz Pacholczyk, Are Feeding Tubes Required?

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