Percutaneous endoscopic gastrostomy techniques are becoming more widely available and will be considered increasingly for patients with head and neck or upper gastrointestinal malignancies, and for neurological dysphagia, as occurs in motor neurone disease. This case history illustrates some of the practical and ethical issues raised by their use.
Copp G., Dunn V.Frequent and difficult problems perceived by nurses caring for the dying in the community, hospice and acute care settings. Palliat Med1993; 7: 19-25.
2.
Donaldson SS , Lenon RAAlterations of nutritional status: impact of chemotherapy and radiotherapy. Cancer1979 ; 43: 2036-52.
3.
Campos Acl, Butters M., Meguid MMHome enteral nutrition via gastrostomy in advanced head and neck cancer patients . Head Neck1990; 12: 137-42.
4.
Saunders JR, Brown MS, Hirata RM, Jaques DAPercutaneous endoscopic gastrostomy in patients with head and neck malignancies . Am J Surg1991; 162: 381-83.
5.
Park Rhr, Allison MC, Lang J. et al. Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia . Br Med J1992; 304: 1406-409.
6.
Forgacs I., MacPherson A., Tibbs C.Percutaneous endoscopic gastrostomy. Br Med J1992; 304: 1395-96.
7.
Moran BJ, Taylor MB, Johnson CDPercutaneous endoscopic gastrostomy. Br J Surg1990; 77: 858-62.
8.
Elia M.Artificial nutritional support in clinical practice in Britain. J R Coll PhysiciansLond1993 ; 27: 8-15.
9.
British Medical Association.Euthanasia report. London: British Medical Association, 1988: 23.
10.
Andrews MR, Levine AMDehydration in the terminal patient: perceptions of hospice nurses . Am J Hospice Care1989; 6: 31-34.
11.
Stone C.Prescribed hydration in palliative care. Br J Nurs1993; 2: 353-57.
12.
Oliver D.Terminal dehydration. Lancet1984; ii: 631.
