Ethical and medicolegal aspects of PEG-tube placement and provision of artificial nutritional therapy.

摘要

The ethics of placing PEG tubes and feeding patients with perceived poor quality of life are complex. The endoscopistoften is placed in a precarious position when PEG-tube placement in such patients is requested. The endoscopistusually serves only as a technician for the enteral access placement, does not always know the patient or the family before PEG evaluation, and does not routinely play a role in the nutritional therapy or follow-up care of the patient. Such practice has evoked criticism for the implication that it violates ethical issues, reduces patient dignity, and fails in any meaningful way to improve outcome.The decision to place a PEG tube centers on the question of the perceived benefit of providing hydration and nutrition to the particular patient. Studies designed to evaluate these issues have to focus both on the morbidity and the mortality related to the procedure, as well as the proposed benefits, which can be difficult to measure (such as changes in the patient's functional status, risk of aspiration, likelihood for developing pressure sores, and quality of life). Such studies have produced varied results, in part because of the inclusion of patient populations with dissimilar comorbidities.Endoscopists who place PEG tubes, particularly in geriatric and patient populations with perceived terminal disease,need to be aware of the ethical and medicolegal aspects of placing tubes and of providing artificial nutrition support in end-of-life decision making.