Thursday, December 15, 2005

Artificial nutrition and hydration redux

Is it because the Holiday eating season is upon us?  Or because this is how long it takes medical journals to solicit and publish papers in response to a national trauma?  Because there's another article about artificial nutrition and hydration that's just been released, this time in the New England Journal of Medicine .  This one is much more mundane than the last one --really it's just a recap of the basic medical, ethical, & legal framework for why stopping ANH can be appropriate.  Their commentary, however, promoted several agenda items that I enjoyed seeing in the pages of The Journal--including improving physician reimbursement for family conferences & removing laws that limit the ability of surrogates to make decisions about forgoing ANH (they rightly argue that ANH should not be treated differently by the law than other medical decisions).  Also appreciated was this:

[D]ecision making about ANH in nursing homes should be shielded from financial and regulatory pressures. Although the loss of the ability to eat is an expected part of dementia, one third of cognitively impaired nursing-home residents have a feeding tube.   Nursing homes should not be reimbursed at a higher rate for residents who are receiving ANH than for those not receiving ANH, since providing ANH costs less than feeding by hand.  In addition, staff and surveyors should be informed that nursing homes should not be cited when a patient loses weight after a decision to forgo ANH.  Finally, publicly reported data on weight loss, which are available on the Centers for Medicare and Medicaid Services Web site, should exclude data for residents whose weight loss is the result of a choice to forgo ANH.

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