Nil by mouth - Oral feeding difficulties and dilemmas

Response to Royal College of Physicians report on inappropriate tube feeding in care homes

The Royal College of Physicians has today published a report, 'Oral feeding difficulties and dilemmas: A guide to practical care, particularly towards the end of life', which highlights the importance of maintaining eating and drinking by mouth for as long as possible in terminally ill patients.

However, leading doctors are concerned that tube-feeding is being inappropriately used in dying patients, including those with advanced dementia; one expert described the procedure as often "unnecessary, unethical and dubious" because it did not prolong life and, due to higher risk of infection, may even shorten it.

Alzheimer Scotland response:

Part 5 (Medical Treatment and Research) of the Adults With Incapacity Act (2000) clearly states that any medical treatment undertaken must be for the benefit of the person being treated and should involve the least restrictive intervention necessary. This should preclude a care home in Scotland insisting on tube feeding before a new resident is admitted (which was one of the key concerns of the report regarding care homes in England). Both clinical staff and care home staff must have regard for the wishes, past and present, of the person with dementia, as far as they can be ascertained, and consult with family and others close to the person as far as possible. Best practice in end of life palliative care must be applied under the clinical guidance of a palliative care specialist.

It is vital that both care home and clinical staff receive appropriate dementia training to help them understand and manage the difficulties associated with feeding in the later stages of the illness and that the necessary time is given to allow nourishment to be given by mouth. If a family member is concerned that tube feeding is being used unnecessarily then we advise that they seek a second medical opinion, which the Adults with Incapacity Act entitles them to do, or contact the Mental Welfare Commission or Care Commission.

- Jan Killeen, Director of Policy, Alzheimer Scotland