George currently has an NG tube. This is a form of clinically assisted nutrition/hydration, a term used to describe all invasive methods of delivering nutrients and fluid such as gastrostomy and intravenous fluids. (BPS 2011).
| Myth | Feedback |
| Decisions on providing George with food and fluid should be made by the doctor alone | Decisions on providing George with food and fluid via an enteral tube should be made by the doctor in partnership with MDT and family
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| Withholding clinically assisted nutrition is ethically better than withdrawing it | It may be emotionally difficult for the MDT and for George’s family to agree to withdraw feeding but there is ethically no difference between withholding and withdrawing clinically assisted nutrition/hydration and this should never be a reason not to initiate feeding in the first place. |
| Gastrostomy feeding will make George better | George’s daughter appears to have high hopes for gastrostomy (e.g. PEG) feeding and believes it will positively alter the course of her father’s stroke. It is important that she understands the limits of offering clinically assisted nutrition/hydration. |
| If George frequently removed his feeding tube this indicates that he doesn’t want it | George is tolerating his NG tube but other patients frequently *dislodge their NG tubes. However, a patient withdrawing a feeding tube does not indicate non-consent to clinically assisted nutrition/hydration. It may reflect agitation or that the tube is irritating the patient in some way.
*For guidance on the appropriateness & use of Nasal Retention Devices & Posey Mitts for patients who frequently dislodge their NG tubes click here |
| You can withdraw or withhold food but not fluid | It is acceptable to do both if indicated by George’s condition. Giving fluids may increase his secretions and add to his burden. Giving fluids can also exacerbate pulmonary and peripheral oedema. |
| Food and fluid, regardless of how is it given is part of core care and cannot be withdrawn | Food and fluid are part of core care but the procedures required to manage George’s NG feed are regarded as medical treatment and can therefore be withdrawn. |
| Fact | Feedback |
| Experience of hunger and thirst are not thought to be distressing at the end of life | As George approaches end of life, his appetite will be decreased and any sensations of hunger and thirst are suppressed.
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| George would still be at risk of aspiration if he had a gastrostomy placed | George has a chest infection and he is not managing his own secretions; research suggests that neither nasogastric nor gastrostomy feeding eliminates the risk of aspiration following stroke. (SIGN 119). For further information on the risks and benefits of tube feeding see the Additional Information box below. |
Page last reviewed: 09 Dec 2021
