Ethics

The research paper concerns ethics in health care, namely, the issue of placing feeding tubes into terminally ill patients. Terminal illness describes an active and malignant disease that cannot be cured and usually causes death of a patient, for example, cancer, heart disease and dementia. A terminally ill patient undergoes various stages, the first one being disbelief, anxiety about the unknown, anger, shock and despair. The second stage is depression which usually occurs after diagnosis.

In the final stages terminally ill patients are unable to walk, take care and feed themselves. From the logical point of view terminally ill patients have no energy to feed through natural system due to health complications and natural loss of appetite. Terminally ill patients are unable to eat and drink enough food to provide basic nutrient requirements. This often requires artificial feeding and hydration through percutaneous endoscopy gastrostomy tubes. However, the use of artificial feeding is considered by physicians as appropriate but from the ethical perspective family members of terminally ill patients think that they starve to death while dying.

Placing feeding tubes into terminally ill patients only prolongs the inevitable and these sentiments are supported by the arguments presented throughout the research paper. The artificial feeding of terminally ill patients can be done through placing the patient on morphine. This  makes  the  patient  feel more comfortable and in most  cases it is a way of  prolonging  terminally  ill  individuals. A terminally ill patient is not in a position to understand his or her body condition and in most cases the agony is so severe. The mind is usually impaired and digestive system very weak due to the lack of basic nutrients from natural feeding process. Logically, artificial feeding is used to supplement natural feeding process but ethically this is a way of forced feeding. Physicians recommend placing feeding tubes to a terminally ill patient at the critical time when the patient is almost dying. Accordingly, it is considered as one of the best ways of supplying basic nutrients that help to fight starvation. Although it is  a  tedious and  painful  process, experts  recommend  that the use  of  morphine  on such patients  help to reduce the agony.

In the recent decades, the artificial feeding for terminally ill patients has been questioned in various nations considering legal, ethical, logical and clinical provisions. The combination of these provisions has led to the global controversy of ethics in health care especially placing feeding tubes into terminally ill patients. The major area of conflict arises in the case of whether it is good or not good to withhold or withdraw artificial nutrition and hydration for terminally ill patients.  Ethically, the life of a patient is very important and needs to be protected and honored.

The issue of the artificial feeding a terminally ill patient must be considered according to the legal provisions because it is a way of supporting the patients autonomy. A controversy arises due to religious beliefs for instance the Catholic Church belief that withholding nutrition and hydration from terminally ill patients results in starvation, dehydration, body weakness and death. In addition, withdrawing artificial nutrition for such patients who are not dying but in a critical condition means that the life of a patient is not morally valued. This means that clinical experts should do anything to make sure that the life of a terminally ill patient is protected.

Clinical argument on withholding artificial feeding

One of the most important and critical objective of physicians is to prevent starvation of patients through artificial feeding. However, clinical officers observe that terminally ill patients cannot live forever and thus placing feeding tubes will not extend life. Health officers argue that terminal illness is not associated with eating and swallowing disorders. Other factors that cause terminal illness which results to nutrition deficiencies and thus use of artificial feeding may not help to prolong the life of such patients. Clinical argument about placing feeding tubes suggests that changes in neurological swallowing system observed in terminally ill patients will not help to increase life expectancy of a sick person.

According to the health research, the use of tube feeding does not prolong the life of a terminally ill patient. A study on terminally ill patients who were totally dependent on others for feeding showed that tube fed and hand fed patients had similar survival rate. This is an implication that placing feeding tubes into terminally ill patient does not prolong the life of the patient. Another study carried by heath experts on terminally ill patients with eating and swallowing disorders showed that natural fed patients had survival rate of 86 in the next one year while tube fed  patients had 10 higher mortality rate. This study was used by clinical experts to conclude that there is no proof to show that tube feeding prolongs life.

Another argument that favors withholding of artificial nutrition through placing feeding tubes into the life of terminally ill patient is that, percutaneous endoscopic gastrostomy (PEG) tubes usually cause suffering. This is manifested by restraints, high complication rates that lead to uncomfortable death. The procedure of placing feeding tubes inflicts a lot of pain that contributes to worse conditions on patients. Aspiration is a major complication that is inflicted by percutaneous endoscopic gastrostomy tubes. This has led to immediate death of terminally ill patient.

Palliative surgical procedures such as biliary and gastric in terminal cancer patients are associated with a higher mortality rate. Other infections related to percutaneous endoscopic gastrostomy tube replacement facilitates contributes to the bad health condition of the patient. Other procedures such as the use of prophylactic antibiotics can be used instead of the artificial feeding. This means that instead of exposing terminally ill patients into pain, doctors can use other methods that are simple and painless to prolong the life of patients. The use of tube feeding is accompanied by use of restraints that add mental suffering to already suffering patients. A study on the use of restraints in both tube fed and non-tube fed patients showed that 78 of terminally ill patients were given artificial nutrition through nasogastric tube. The use of PEG tubes requires restraints more than use of nasogastric tubes and this is advancement in technology. It is more comfortable to use PEG tubes because patients are not irritated and there is reduced suffering.

In contrast to the above arguments, as a matter of logics, withholding nutrition is one way that cuts short the life of terminally ill patient. The acknowledgement of nutrition importance brings out clearly the logical argument about artificial feeding on terminal illness. The controversy is being experienced by different health organizations and clinical provisions and the debate range even in the current decade. The life of terminally ill patient in the late stages can be prolonged for a long period if doctors administer such patients with artificial nutrition. The use of PEG advanced technology prolongs life of patients who are not in a position to orally eat. The rate of complications is reduced and suffering in patients is reduced. Thus, there is need to place feeding tubes into terminally ill patient to prolong their lives.

Terminally ill patients need much care and concern because they are usually in depression and a minor complication like the lack of nutrients results to immediate death. Supportive care is only possible through placing feeding tubes that provides the necessary nutrients thus prolong patients life. Health complications such as throat cancer make the sufferer to have difficulties while swallowing. This definitely calls for the use of feeding tubes that help to supplement natural feeding and thus provide the necessary nutrients. This argument outweighs the issue of clinical observations about withholding feeding tubes into the life of terminally ill patient.

An important thing to note about terminally ill patients is that they undergo difficult times due to their health conditions and to avoid starvation there is need to artificially provide basic nutrition. Starvation is a major factor that leads to worse condition of terminally ill patient. This can be avoided through artificial feeding so as to give the patient energy, hope and prolong his or her life. Feeding tubes should be recommended by clinical officers as a way of prolonging patients life. A terminally ill patient has short expectancy life span and through artificial feeding his or her life span is prolonged.

Ethical arguments
Placing feeding tubes into terminally ill patients has resulted in ethical arguments on whether it is necessary to withhold or withdraw artificial feeding. Ethically, withholding of artificial feeding and allowing nature to take its course is morally right. The assumption is that since at one time the patients will die thus any other matter that may result to their death like starvation is highly appreciated. The patients can be kept alive but starvation can be used as one of the best method to allow terminally ill patients rest especially when the illness reaches advanced stages.
The patients should be allowed to die without suffering. The legal system in many parts of the world has incorporated ethical sentiments such as the principle of autonomy. This has led to advancement in ethical developments about tube feeding. Terminally ill patient is mandated to choose whether he or she needs medical therapy through tube feeding. Artificial feeding is considered as extraordinary care and mechanical ventilation which is not supported by ethical provisions.

In other instances, the distinction between terminal and non-terminal diseases is important. Initiation of   mechanical ventilation in terminally ill cancer and tube feeding on demented patients is not comparable. The issue about placing feeding tubes on terminally ill patient is the decision of the patient, family members, clinical officers and legal provision. The ethical aspect of whether to withhold tube feeding requires qualitative analysis among various parties. In various terminal illnesses such as dementia, failing to eat is a natural form of letting the patient to die.

Starvation through the lack of basic needs results in immediate death of a terminally ill patient. This eases the duties of clinical officers and other close family friends who are always under the observation of the patient. Placing feeding tubes into terminally ill patients aims at improving the physiological effects and rarely does it improve on the quality of life. This situation in the ethical aspect calls fro physician to withhold tube feeding. This is true because the patient in the long run does not benefit and it helps to minimize wastage of resources. Family  members think that placing feeding  tube into terminally  ill patient is not  ethical because  nourishing  is only for  a short period  of  time and then the patient dies.

It is true that the human life according to ethics is important, but sometimes when a patient is seen to suffer extensively he or she should be allowed to rest. The physician should in certain instance read the moods of family members about a terminally ill patient and ignore the use of tube feeding. Such instances include particular situations when the patient is so weak and his or her condition is very bad such that artificial feeding is no of any importance. Ethically, doctors or physicians are allowed to place terminally ill patients on morphine so as to die without suffering. The use of morphine by doctors incase of a terminal illness is one of the best ethically recommended method of letting go a terminally ill patient. Legally placing a terminally ill patient is allowed because the patient rests without suffering although his or her life may be cut short.

On the other hand, it is necessary to help a terminally ill patient live until his or her final day without use of other methods that leads to immediate death. The ethical element is observed in the principle of autonomy whereby every individual has right to life. The physicians should use artificial nutrition to help patients with terminal illness get the basic nutrients to avoid starvation. Even if the patient is supposed to die at one time but the physicians should try their level best to prolong his or her life.
Importantly, terminally ill patients are human beings and due to their health situation they cannot lead a normal life, therefore, they should not be discriminated. Withholding tube feeding on terminally ill patient is ethically right, because it is one way of exercising the right to life. The procedure of placing feeding tubes into terminally ill patients is costly. Many terminal patients may not be in a position to afford PEG tubes and thus it is not wise to invest in an unproductive project. Instead of tube feeding the patient should engage him or herself in activities that help to prolong their lives through doing exercise.

Conclusion
The human life is important and irrespective of the terminal illness patients in such category should be treated with a lot of care and concern. Physicians, family members and legal system should work hand in hand to prolong the life of terminally ill patient through tube feeding. Patients who have swallowing and eating complications are supposed to be put under tube feeding so as to avoid them starve. In situations where the suffering is unbearable the physician is legally allowed to place the patients on morphine to rescue them from such pain.