A 73-year-old man has been brought to a chronic_care facility for long_tcrm ven_ tilator nanagement. The patient has advanced COpD and is unable to be weancd from the ventilator. A trachcostomy h-as been placed. A nasogastrie tube is in place to.deliver tube feeding. The patient is fully alert, and understaids the situation. He is asking to have the nasogastrie tube renroved because of discomfort.
what should you tell him?
a. "I will get that tube out right away, sir.,
b. "l,et’s
see how much you are atrle to eat first.,
c. "I will pull it out if you let me put in a gastric tube.,
d, "Let
me talk to your family first.,
e. "Do
you havc a health-care pror1,?,
f. "No
way dude, we make the clecisiorrs arouncl here, not you.,
g. "Only if you promise not to sue me.,
h. 'Arc
you crazv? Do you think I am going to let My patient starve to death?,
(a) “I will get that tube out right away, sir.”
An adult patient with the capacity to understand his mcdical problems has the right
to stop any form of therapy he wants to. This patient gives the reason that he is
uncomfortable, however, the patient does not have to give you any reason. He can
just say,
“I do not want it,” and you must stop. There is no evidence of psychosis or
depression described in the case so there is no reason to doubt the decision making
capacity of the patient.
\4hen the patient has the capacity to understand, the wishes of the faniily, the
courts, or the pro)!l. are not relevant to what you have to comply with in terms of the
patient’s care.
There is a big difference between not complying with a patient’s wishes for himself
and not agreeing with the decision. You do not have to agree with a conpetent
person’s wishes for himsell but you do have to comply with them.
Removing tube feeding in a person who needs the nutrition has a different emotional
feeling for many caregivers because it seems like denying basic comfort. Nevertheless,
there is no legal or ethical distinction. Tube feedings are a medical intervention that
can stop like any other at the discretion ofthe patient. You cannot force-feed a patient
asainst their will.