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Deaths after feeding-tube withdrawal from patients in vegetative and minimally conscious states: A qualitative study of family experience

Palliative Medicine 2018, Vol. 32(7) 1180–1188 (Editor's Choice)

Each month, one article from Palliative Medicine, the EAPC's official research journal, is selected as 'Editor's choice' and the author invited to contribute a short post to the EAPC blog explaining the background to the full article in the journal. This month's 'Editor's choice' is described below with access to the free PDF version.  (You can also read the blog post version here)

Abstract
Background: Families of patients in vegetative or minimally conscious states are often horrified by the suggestion of withdrawing a feeding tube, even when they believe that their relative would not have wanted to be maintained in their current condition. Very little is known about what it is like to witness such a death.
Aim: To understand these families’ experience of their relatives’ deaths.
Design: Qualitative study using in-depth narrative interviews analyzed inductively with thematic analysis.
Participants: A total of 21 people (from 12 families) whose vegetative or minimally conscious relative died following court-authorized withdrawal of artificial nutrition and hydration. All had supported treatment withdrawal.
Findings: Interviewees were usually anxious in advance about the nature of the death and had sometimes confronted resistance from, and been provided with misinformation by, healthcare staff in long-term care settings. However, they overwhelmingly described deaths as peaceful and sometimes even as a “good death.” There was (for some) a significant “burden of witness” associated with the length of time it took the person to die and/or distressing changes in their appearance. Most continued to voice ethical objections to the manner of death while considering it “the least worst” option in the circumstances.
Conclusion: Staff need to be aware of the distinctive issues around care for this patient group and their families. It is important to challenge misinformation and initiate honest discussions about feeding-tube withdrawal and end-of-life care for these patients. Families (and staff) need better support in managing the “burden of witness” associated with these deaths.

Keywords

Artificial feeding, end-of-life care, minimally conscious state, qualitative research, tube feeding, vegetative state

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