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KFCA said:With that somewhat landmark case going on in Florida, it made me wonder what was the medical history of the modern feeding tube? And what, if anything, was done previously?
The modern feeding tube is also known as a gastrostomy tube, G-tube or PEG (Percutaneous endoscopic gastrostomy). Many styles of gastrostomy tubes have been developed and used over the last 20 years by patients requiring long-term feedings. As an alternative to the use of the traditional gastrostomy tube, the low profile gastrostomy device (LPGD) was introduced in the mid-1980s. Prior to the deveopment of the PEG individuals who couldn't swallow (many with neurmuscular diseases) were fed through naso-gastric or Levin tubes which did not require surgery. So the idea is not new. I recall G-tubes used in infants with congenital esophageal abnormalities during my training back in the early 70s. And adults with ALS and other diseases affecting the swallowing reflex being fed through Levin tubes around the same time and long before that.
For an overview of prior court cases on this subject see:
www.med.umn.edu/bioethics/publications/RP2.pdf
This classic paper provides an overview of the subject which many may find pertinent.
Apropos our discussion, here is an abstract of a report on this subject from 1986:
Hastings Center Reports. 1986 Feb;16(1):28-30.
Why food and fluids can never be denied.
Derr PG.
KIE: Derr, a philosopher, served as an expert witness in Brophy v. New England Sinai Hospital (decided 21 October 1985), in which a Massachusetts probate court ruled that a gastrostomy tube could not be removed from a patient who had been in a persistent vegetative state for more than two years. Printed here is an edited version of Derr's testimony, during the course of which he presents "six mutually reinforcing biological, social, historical, and ethical considerations" which he believes distinguish withholding or withdrawing food and fluids from withholding or withdrawing medical or surgical therapies. He warns that a social and legal decision to deny food and fluids to patients like Paul Brophy would attack the ethical foundations of law and medicine, and argues that the distinction between sustenance and therapy should be sustained.
Gastrointest Endosc Clin N Am. 1998 Jul;8(3):611-21.
Design and production of enteral feeding tubes.
Hirsch WH, Piontek CJ.
Ross Products Division, Abbott Laboratories, Columbus, Ohio 43215, USA.
The evolution of enteral feeding via tubes, syringes, and other mechanical devices probably began in Egypt before the birth of Christ. Today's feeding tubes are a safe and effective means for providing long-term feeding to patients unable to maintain sufficient nutrition by oral intake. The needs of enterally-fed patients are presently being met with feeding tubes that are biocompatible, easy to use, and relatively inexpensive to manufacture.