Oral feeding difficulties and dilemmas

Oral feeding toward the end of life can be fraught with dilemmas for health professionals dealing with patients who cannot clearly give their views. On the one hand, is providing artificial feeding an essential requirement and failing to do this tantamount to manslaughter, or is it assaulting a frail and dying individual?

A recent report by a working party from the Royal College of Physicians (RCP) and the British Society of Gastroenterology (BSG) (2010) aims to give some background information to assist health professionals from all disciplines in arriving at a balanced decision that is in the patient’s best interests. The report focuses largely on decisions surrounding percutaneous endoscopic gastrostomy (PEG) and nasogastric (NG) feeding. Speech and language therapist expertise can be used to guide modified food intake, and adapting foods and assisting feeding can enable a more normal daily life and the social interaction so easily lost with artificial feeding. Sometimes tube feeding may be necessary as back up, but wherever possible oral intake should be preserved.