To the Editor: Many patients in the terminal
phase of dementia have difficulty swallowing, with resulting weight loss and
recurrent aspiration. Feeding tubes are often used for patients with advanced
dementia in the hopes of delaying death or enhancing the quality of life,
but the evidence supporting this practice is questionable.1,2
Although none of the 50 states prohibit the forgoing or withdrawal of a feeding
tube, 15 states require a written advance directive to forgo insertion of
a feeding tube.3 Aronheim et al,4 however, noted that variability in state laws did
not fully explain the differences between states in use of feeding tubes.
We sought other explanations for interstate variation in use of feeding tubes.
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Prepared by Brown Medical School, Center for Gerontology and Health
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