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September 1989

Understanding the Benefits and Burdens of Tube Feedings

Author Affiliations

Division of General Internal Medicine University of California 400 Parnassus Ave San Francisco, CA 94143-0410; Veterans Administration Hospital 3801 Miranda Ave Palo Alto, CA 94304

Arch Intern Med. 1989;149(9):1925-1926. doi:10.1001/archinte.1989.00390090007001

Tube feedings for patients with severe dementia, metastatic cancer, or stroke present controversial management decisions. Artificial feedings might benefit patients by reversing malnutrition or dehySee also p 1937. dration and prolonging life in patients who are unable to take adequate nutrition by mouth. But Quill's1 careful empirical study shows that feeding tubes may not accomplish these goals and may impose significant burdens on patients with severe, irreversible illness.

TECHNOLOGY SHOULD BENEFIT THE PATIENT  Philosophers have asserted that medicine should benefit the patient, according to the patient's definition of benefit.2 Feeding tubes can benefit patients when they provide time to treat underlying medical problems or clarify prognosis or when prolongation of life is feasible and desirable. But Quill found that feeding tubes seldom gained time for underlying reversible conditions to be successfully treated. In only two cases were feeding tubes removed because patients improved. It is questionable whether feeding

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