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

在日本，从2000年左右开始，老年患者的经皮内窥镜胃造口术（PEG）手术稳步增加，这引发了一种批评，即经常进行不必要的PEG。针对这一批评，家访护士面临的伦理困境进行了研究，在决定是否肠内营养的PEG应该引入到老年患者生活在家里有困难的食物摄入的情况下。调查显示，家访护士在以下三种情况下存在严重的伦理困境：1）他们认为侵犯了病人的自决权; 2）即使是在病人和家属同意的情况下，也会引入PEG; 3）护士对PEG的看法没有与病人和家属讨论。

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.