When to Recommend a PEG Tube: A Decision Tree for Clinicians from a Catholic Perspective

Abstract

The question of tube feeding often presents great challenges for the physician. Catholic moral teaching can be of great help to all people of good will in meeting this challenge. The Church teaches that tube feeding is, in principle, ordinary care and hence morally obligatory. How should clinicians go about deciding when to recommend tube feeding in a manner that serves the best interests of the patient and is in harmony with the Church's teaching? A PEG tube should be recommended when a patient is not eating or drinking adequately, has more than a short-term need, is not imminently dying, and has no contraindication to a PEG. This article presents a step-by-step discussion of the decision-making process to assist physicians and other health-care professionals. A decision tree is included that is clinically focused, practical, and straightforward. The authors represent a broad range of Catholic clinical experience. Practical suggestions are offered regarding how to go about discussing this difficult subject with patients and their families. The issues of patient refusal, advance directives, and physician recusal from care are addressed. A chronological reading list on the subject of PEG tubes is provided.