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Best-interests decision about tube feeding — SCE Geriatric Medicine MCQ

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HardEthics and lawBest-interests decision about tube feedingSCE Geriatric Medicine

An 84-year-old woman with recurrent falls has a Clinical Frailty Scale score of 7 and advanced Parkinson disease. She is admitted with aspiration pneumonia and has recurrent distressing choking despite SLT input. She lacks capacity; her husband says she previously feared being kept alive by tubes. The team is considering nasogastric feeding. What is the most appropriate management?

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Correct answer: B — Hold a best-interests discussion weighing burdens and benefits of tube feeding against her known values

When a patient lacks capacity, decisions about clinically assisted nutrition and hydration require a best-interests process considering benefits, burdens, prognosis and the person's past wishes and values. The husband's views are important evidence but do not make him the sole decision-maker unless relevant legal authority applies. Tube feeding may be burdensome and may not prevent aspiration in advanced neurodegenerative disease. The pearl is that nutrition decisions are treatment decisions requiring the same ethical rigour as other interventions.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/neurological-conditions/dementia