Determine the patients' competence and determination of tube feeding of Elderly Dying at Home

在日本，从2000年左右开始，老年人的经皮内窥镜胃造口术（PEG）手术持续增加，引发了不必要的PEG手术的批评。针对这些批评，我们考察了家访护士面临的伦理困境，即是否应该向有食物摄入困难的居家老年患者引入PEG肠内营养。调查发现，家访护士在以下三种情况下存在严重的伦理困境：1)认为患者的自决权受到了侵犯；2)即使是在患者和家属同意的基础上引入了PEG； 3)护士对PEG的看法没有与患者和家属讨论。

In Japan, an steady increase of percutaneous endoscopic gastrostomy (PEG) procedures for elderly patients from around 2000 has stirred up a criticism that unnecessary PEG has often been performed. In response to the criticism, an ethical dilemma faced by home-visiting nurses was examined in the case of deciding whether or not enteral nutrition by PEG should be introduced to elderly patients living at home who had difficulty with food intake. The survey revealed that home-visiting nurses had serious ethical dilemma in the following three cases: 1) they thought that patients’ right of self-determination was violated, 2) PEG was introduced even if the decision was based on the consent of a patient and the family, and 3) the nurses’ view on PEG was not discussed with a patient and family members.