The role of tube feeding and total parenteral nutrition in advanced illness.

Consumption of food and drink is a fundamental part of North American culture. “All-you-can-eat” diners and lavish Thanksgiving turkey dinners are as American as Mom and apple pie. Eating and drinking is a valued social activity; we derive our strength from eating, and for many, the ability to eat and drink symbolizes life itself. The development of artificial nutrition has allowed us to feed patients who cannot eat and to continue to feed patients who are dying. It is no wonder that withholding food or withdrawal of artificial feeding may be seen as tantamount to assisted suicide or euthanasia by patients, families, and health professionals. Because placement of a feeding gastrostomy or jejunostomy often falls to the surgeon, the role of tube feeding and total parenteral nutrition (TPN) in advanced illness is an appropriate subject for our review. Two case scenarios help focus the issues at stake.