Feeding Tubes – To Place or Not to Place?

Sometimes I have to pinch myself. Is this really my twenty-fifth year of practice as a palliative care physician? My head is full of memories of caring for hundreds of patients as they navigate their final days of life.

I think of the first patient I placed on hospice in my first week of practice as a newly minted attending. At eighty-eight years old, Mrs. C. had been perfectly functional and even driving herself. But now she arrived at rehab after a sudden massive stroke. Her daughters were holding out hope for improvement. She was unable to maintain nutrition due to dysphagia (difficulty swallowing) and a feeding tube was placed in the hospital. Her oldest said, “We were told this was temporary, and the tube could be removed anytime.”

We moved Mrs. C. into intensive rehabilitation. She made minor progress, but a month later was still unable to walk, talk or eat.

Mrs. C. looked miserable, but her family kept hoping for a miracle. Ninety days passed with no measurable improvement. She would need custodial care.

It was the harsh reality of economics that made the daughters agreeable to having a realistic conversation with us. “We were told we could pull the tube at any time. That’s why we went with it.” “Are we killing mom if we stop feeding?” “But she would never have wanted to live on a tube when the rest of her body is not cooperating.”

A few minutes later, again “But will we be killing mom if we stop feeding? Will God ever forgive us?”

And, “I wish we had never agreed to a tube. We made her miserable for nothing. We robbed her of the chance to have a peaceful journey.”

It was an emotional conversation as these tend to be. We as medical professionals have to be careful with saying “feeding tubes may be temporary and can be removed at any time” because even though ethically withholding versus withdrawal of feeding maybe theoretically equal, the trauma of making a decision to withdraw is exceedingly painful.

After deliberation, the daughters agreed to hospice. Within days, she had another massive stroke and became unresponsive and regurgitated feeding. The decision to stop was not difficult for the family anymore.

The daughters told us, “Mom made a decision for herself and spared us agony. We are not sure if we could’ve lived with ourselves had we stopped feeding. She was a wonderful mom even at the end!”

Neeta Nayak
Richardson, Texas