I am once more discussing the issue of tube feedings in the individual who is at end-of-life.  I have come to realize that part of the difficulty in make a decision re: feeding tube insertion is the emotional connection we all have between feeding and love.

Our first maternal relationship after birth centers around feedings and this emotion-laden association never ends.  The thought of withholding feeding for a loved one, the belief that to do so is to purposely ‘starve’ someone we love, is a horrendous, unacceptable thought.

The difficulty arises, therefore, because of a misunderstanding of what occurs in the dying process and our own emotional needs as regards our loved one.

Human beings who are have reached an end stage in life, whether due to cancer, heart disease, pulmonary disease, renal disease, or dementia usually do not want to eat.  Their anorexia represents a total body reaction to what is occurring.  All organs are shutting down in anticipation of impending death and the digestive organs are no exception.

In a situation in which there is no reasonable hope for recovery and in which the natural process of dying is accelerating, any attempts to force the individual to eat is actually increasing their suffering.

The act of personally attempting to feed a loved one, at their bedside with a spoon or fork, highly emotionally charged and emanating from a deep love and inability to come to terms with their impending end is totally understandable and fine.

This is very different from having a feeding tube placed through their abdominal wall and having nutritional supplements pumped directly into their stomachs.  This is hardly a tender, loving mode of nutritional supplementation

Feeding tubes [PEGs] clearly have their place in those patients who have a reasonably long life expectancy and who need chronic nutritional support.  This is not the case with those at end-of-life.

In these cases, not inserting a feeding tube is a true act of love.

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