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Supporting Life through Tube Feeding: Factors Influencing Surrogate Decision-Making

Published online by Cambridge University Press:  29 November 2010

Donna Wilson
Donna Wilson
Affiliation:
University of Alberta
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Abstract

Many individuals have tube feeding implemented in the end stages of life. It is also common to have surrogates making life support decisions for others. When family members are placed in the role of decision-maker for an incompetent patient, what factors influence life support decisions? A case study and ethnomethodological inquiry provide an in-depth understanding of factors that influenced one daughter in her decision to have tube feeding implemented for her incompetent and severely debilitated mother. The decision was difficult and constituted a time of crisis. Unfortunately, the most influential factors in decision-making were: (a) urgency in the face of impending death, (b) lack of insight into the mother's values and preferences in relation to life support through tube feeding, (c) lack of knowledge over what tube feeding involved, and (d) the belief that tube feeding would not prolong her mother's life and suffering. Nine other, less influential, factors were also found. Improving the sensitivity of health care professionals to the agony of decision-making and to the decision-making process for life support are the major focuses of this paper.

Résumé

Un grand nombre de personnes ont besoin d'une sonde au cours de la dernière étape de leur vie. Par ailleurs, la décision du maintien des fonctions vitales revient souvent à une autre partie. Lorsque les membres d'une famille sont tenus de prendre cette décision pour un patient incompétent, quels facteurs influenceront leur choix? Une étude de cas et un sondage ethnométhodologique ont révélé clairement et en détail les facteurs ayant influencé une femme devant décider si les fonctions vitales de sa mére en état d'incapacité totale et de grave débilité devaient être maintenues au moyen d'une sonde pour gavage. La décision était difficile à prendre et survenait à un moment critique. Malheureusement, les facteurs ayant eu la plus forte influence furent les suivants: a) le besoin pressant d'une décision en raison d'un décès imminent; b) une lacune quant à la connaissance des valeurs et des préférences de la mère au sujet du maintien de ses fonctions vitales au moyen d'une sonde pour gavage; c) un manque de connaissance quant à la réalité de l'alimentation par sonde; et d) la croyance que cette mesure ne prolongerait pas la vie ni la souffrance de la mère. De plus, neuf autres facteurs, moins importants, ont été déterminés. Cette étude est principalement axée sur l'amélioration de la sensibilité des professionnels de la santé vis-à-vis de l'angoisse qu'éprouvent les gens à décider de maintenir les fonctions vitales d'un proche et du mode de décision en tant que tel.

Keywords

Decision-makingEnteral Tube FeedingLife SupportEthnomethodology.Prise de décisionsalimentation par sonde entériquemaintien des fonctions vitalesethnométhodologie.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 12 , Issue 3 , Fall/automne 1993 , pp. 298 - 310
Copyright
Copyright © Canadian Association on Gerontology 1993

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