Doctors condemn feeding tubes for the old

Many homes are said to be closing their doors to patients who do not have “nil by mouth” tubes inserted into their stomachs.

Although managers claim to be acting in patients’ interests, the real motive may be to cut costs and save on staffing, according to the authors of a report from the Royal College of Physicians.

The disclosure came as the College issued guidelines urging doctors and nurses to view artificial feeding as a “last resort”.

An audit of 719 procedures published in 2004 found 19 per cent were “futile” and did nothing to prolong life. This finding suggests large numbers of patients are being fed “nil by mouth” inappropriately.

A 2008 survey showed the previous year 39,000 people in the UK were artificially fed outside hospital, either at home or in residential care.

Dr Rodney Burnham, who co-chaired the working party that produced the guidelines, said increasing numbers of homes were refusing to take patients not fitted with feeding tubes.

“We come down very strongly on any blanket refusal on those grounds,” he said. “They may cite patient safety but there could be a hidden agenda on grounds of staffing or costs.”

He was unable to say what proportion of homes imposed the rule, but added: “It is fairly widespread, because every hospital and every nutrition team you talk to will have had that experience.”

He said the procedures were invasive and involved a significant element of risk. Death rates of patients given tubes were 6 per cent on average after 30 days and in some cases as high as 30 per cent. Nearly a third of patients suffered ill-effects.

Dr David Sanders, of the British Society of Gastroenterogy, who co-chaired the working group, said the practice was most questionable when patients such as those suffering from dementia could not give their consent.

“I think if a patient is not in a position to make that decision and tube feeding is futile, it is unethical on a legal basis,” he said. Such intervention was “actively unethical and dubious”.

The professional guidance was issued against a background of 39 per cent of hospital in-patients in the UK being malnourished.

It called for a multi-disciplinary approach that involved doctors and nurses working together with patients and their families.

Feeding by mouth was recognised as essential to quality of life, and worth preserving even when a patient had difficulty swallowing.

“Nil by mouth should be a last resort, not the initial default option,” said the report.

The guidelines said hospitals and care homes should ensure the provision of sufficient staff to assist and feed patients who may take a long time to eat a meal.

Where tube feeding was necessary, it should only be carried out with “clear clinical objectives in mind”.

The report also made it clear that the wishes of relatives should not be allowed to override a patient’s interests.