PEGs and ethics revisited: a timely reflection in the wake of the Terri Schiavo case.

Percutaneous endoscopic gastrostomy is an accepted technique for long-term enteral feeding. The demand of percutaneous endoscopic gastrostomy placement continues to increase because of the increasing numbers of vulnerable patients with chronic diseases coupled with the relative ease of insertion, and societal ambivalence about such treatment. Despite the demand and improvements in placement technique, the issue of tube feeding in vulnerable patients remains an ethical minefield, leading to considerable discussion and debate. This contentious area of clinical ethics is further complicated by the recent papal allocution regarding artificial nutrition and hydration. The case of Terri Schiavo should serve as a timely reminder of those problematic clinical and ethical issues inherent in percutaneous endoscopic gastrostomy placement and feeding in vulnerable patients.     

Managing pain, managing ethics.

Noncompliance of family caregivers can present home hospice nurses with difficult ethical choices and powerful feelings about those choices. This is particularly so when family members do not adequately palliate their loved ones, resulting in treatable symptom distress during the dying process. This article presents a case study, moral analysis, and an evidence-based, practical plan of action for engaging family members of palliative care patients on a home hospice service.