Author
End-of-life care in paediatrics often encounters the very emotional and fraught dimension of Nutrition Ethics. In a medical milieu where 'PEGs' are inserted within two blinks of a nasogastric, there has evolved a view of enteric feeding as 'normal' and a basic right. In most cases the use of such feeding brings a quality to life and a capacity to give not only feed but also administer medication simply and safely. But what if the child is suffering to be fed? What if they moan and squirm their way through each feed, if they live a cycle of vomiting, aspirating and choking? What if they have no hunger and to start enteric feeding is to prolong suffering other symptoms ... but they are in a Neonatal Intensive Care Unit? Why don't we see tubes for feeding as artificial means of sustaining life which can actually cause harm? If we can remove a nasogastric tube, can we remove a PEG that become a leaking burden? How do we navigate the responses of families and clinicians to find the best path for the child? So many questions, worthy of some compassionate, purposeful and objective exploration. Sara Fleming has the clinical experience which has seen many of these situations. This year her team has devoted education time and ethicist musing to wrestling with the concept. This session will explore these issues with case reflections and sharing of literature wisdom. It will work with the room to roll around the angst and identify the practical ways forward to approach these challenges. Be ready to think, to feel and to commit to some changes in language and viewpoint.
- Sara E Fleming1
- Women's and Children's Hospital1
2015
ExcerptEnd-of-life care in paediatrics often encounters the very emotional and fraught dimension of Nutrition Ethics. In a medical milieu where 'PEGs' are inserted within two blinks of a nasogastric, there has evolved a view of enteric feeding as 'normal' and a basic right. In most cases the use of such feeding brings a quality to life and a capacity to give not only feed but also administer medication simply and safely. But what if the child is suffering to be fed? What if they moan and squirm their way through each feed, if they live a cycle of vomiting, aspirating and choking? What if they have no hunger and to start enteric feeding is to prolong suffering other symptoms ... but they are in a Neonatal Intensive Care Unit? Why don't we see tubes for feeding as artificial means of sustaining life which can actually cause harm? If we can remove a nasogastric tube, can we remove a PEG that become a leaking burden? How do we navigate the responses of families and clinicians to find the best path for the child? So many questions, worthy of some compassionate, purposeful and objective exploration. Sara Fleming has the clinical experience which has seen many of these situations. This year her team has devoted education time and ethicist musing to wrestling with the concept. This session will explore these issues with case reflections and sharing of literature wisdom. It will work with the room to roll around the angst and identify the practical ways forward to approach these challenges. Be ready to think, to feel and to commit to some changes in language and viewpoint.