Geriatric Unit, Bnai Zion MC, Haifa, Israel.
Technion Israel Institute of Technology Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Age Ageing. 2018 Jan 1;47(1):138-143. doi: 10.1093/ageing/afx161.
advanced dementia is an incurable illness, its last stage marked by inability to eat. Tube feeding was deemed a helpful solution at this stage, but in recent years its inefficiency has been proved, and it is no longer practiced in many countries around the world. In Israel, however, the procedure is still accepted. In the gastroenterology department at the Bnai Zion Medical Center, a serious interaction is ongoing with patients' legal guardians, where detailed information is given about the inefficiency of the tube procedure. Nevertheless, the great majority of guardians choose to have it performed.
to probe the considerations underlying the decision for gastrostomy, despite the data and the recommendations.
qualitative research, including participant observation at the clinic and in-depth interviews with guardians.
the families of most patients did not discuss end-of-life issues with them. The overwhelming preference for using the technology was interpreted as life-saving, in contrast to comfort feeding, which was deemed euthanasia. The reasons given for the decision to tube feed were drawn from a range of outlooks: religion, the patient's earlier survival capacity, and pragmatic considerations involving relations with nursing home staff.
study of the decision-making process of advanced dementia patients' guardians sheds light on the layers of meaning of the Israeli discourse regarding end-of-life issues.
晚期痴呆是一种无法治愈的疾病，其最后阶段的特征是无法进食。在这个阶段，管饲被认为是一种有帮助的解决方案，但近年来，它的效率已经得到证实，在世界上许多国家已经不再使用。然而，在以色列，该程序仍然被接受。在 Bnai Zion 医疗中心的胃肠病学部门，与患者法定监护人之间正在进行一场严重的互动，详细介绍了管饲程序的无效性。尽管有数据和建议，但绝大多数监护人仍选择进行该程序。
探究尽管有数据和建议，但仍决定进行胃造口术的考虑因素。
定性研究，包括在诊所进行的参与者观察和对监护人的深入访谈。
大多数患者的家属没有与他们讨论临终问题。绝大多数人将使用该技术的强烈偏好解释为救命，而不是安乐死。决定进行管饲的理由来自各种观点：宗教、患者之前的生存能力以及与养老院工作人员关系方面的实际考虑。
对晚期痴呆患者监护人决策过程的研究揭示了以色列关于临终问题的论述的多层次含义。
