Nil by mouth a 'last resort'

13 January 2010

Tube feeding of patients near the end of life should be a 'last resort' according to a Working Party report published by the Royal College of Physicians and the British Society of Gastroenterology.

Oral feeding difficulties and dilemmas: A guide to practical care, particularly towards the end of life has been produced in response to continuing unease about the lack of consensus among healthcare professionals about when artificial nutrition and hydration is appropriate. A multidisciplinary team of healthcare professionals with an interest in nutrition matters, medico-legal experts and patient representatives reviewed the clinical and ethical arguments surrounding the tube feeding of those patients experiencing swallowing difficulties either as a result of neurological illness or other substantial disabilities.

The group recommends that oral intake should be the main aim of a nutrition strategy at the end of life. Even if a patient is deemed to have an 'unsafe swallow', a risk management approach may offer them the best quality of life. 'Nil by mouth' should be a last resort, and where tube feeding is necessary it should be "additional" and with clear clinical objectives in mind.

The report also stresses that decisions should never be based on the convenience of staff or carers. Nor should artificial feeding be required as a criterion for admission to any kind of institution providing care.

Dr. Rodney Burnham, Co-Chair of the Working Party said:

"This report brings considerable and much overdue clarity to a very challenging area. Feeding difficulties can create great uncertainties and even confusion among healthcare professionals, as well as patients and relatives. The College expects it to become an invaluable resource for those who are trying to grapple with these difficult issues."

Copies of the report are freely available for download in the members’ section of the RCP website, or for sale in hard copy or pdf format to non-RCP members through the online bookshop (http://www.rcplondon.ac.uk/)