King’s College London Student Clinical Ethics Committee case discussion: is it appropriate to insert a percutaneous endoscopic gastrostomy for an elderly man who has already pulled out a naso-gastric tube?

Members of the Student Clinical Ethics Committee discussed whether tube feeding should be instigated for a man who had indicated through his actions that he may be refusing it, although his family stated that he would have wanted to be kept alive in such a situation. The Committee considered the key issues of capacity and best interests, which in this case were confounded by lack of clarity about whether the patient’s actions amounted to a valid refusal of life sustaining treatment, and if his previous views still pertained to his current, yet unforeseen, circumstances. As the discussion progressed, it became apparent that some members were reluctant to accept that non-insertion of clinically assisted feeding could ever be in a patient’s best interests.