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PEG-Ernährung bei fortgeschrittener Demenz

Eine evidenzgestützte ethische Analyse

Tube-feeding in advanced dementia

An evidence-based ethical analysis

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Zusammenfassung

Entscheidungen über eine Sondenernährung bei Patienten mit fortgeschrittener Demenz gestalten sich aufgrund der unklaren empirischen Evidenz und komplexen ethischen Verpflichtungen in der klinischen Praxis oftmals schwierig. Im Folgenden werden ethische Kriterien und empirische Evidenz erstmals systematisch zusammengeführt. Diese Analyse unter den Kriterien des Wohlergehens, des Nichtschadens und der Autonomie zeigt, dass bei vielen Patienten mit fortgeschrittener Demenz auf eine Sondenernährung verzichtet werden sollte: Neuere empirische Studien demonstrieren, (1) dass es keinen Nachweis eines Nutzens gibt, (2) dass eine PEG-Ernährung einem Demenzpatienten oftmals weiteren Schaden zufügt und (3) dass der erklärte bzw. mutmaßliche Patientenwille zumeist nicht ausreichend beachtet wird. Ein praxisorientiertes Modell zur interdisziplinären Entscheidungsfindung wird diesen verschiedenen Schwierigkeiten gerecht und könnte die empirisch und ethisch anspruchsvolle Entscheidungsfindung zur PEG-Ernährung bei fortgeschrittener Demenz wesentlich erleichtern.

Summary

Lacking clear empirical evidence and ethical obligations, decision-making about tube-feeding in patients with advanced dementia often presents as a difficult problem in clinical routine. Based on the principles of beneficence, non-maleficence and autonomy, an ethical analysis of the empirical evidence shows that tube-feeding should be avoided in many patients with advanced dementia: Recent studies demonstrate (1) that there is no proof of any benefit, (2) that tube-feeding often results in further harm to the dementia patient and (3) that the patient’s will is not sufficiently taken into consideration. A practical model for interdisciplinary decision-making can account for these various difficulties and might improve the empirically and ethically highly complex process of decision-making about tube feeding in patients with advanced dementia.

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  1. Institut für Ethik und Geschichte in der Medizin, Universität Tübingen, Schleichstraße 8, , 72074 , Tübingen , Deutschland

    M. Synofzik

  2. Abteilung für Kognitive Neurologie, Hertie Institut für Klinische Hirnforschung, Tübingen, Deutschland

    M. Synofzik

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Synofzik, M. PEG-Ernährung bei fortgeschrittener Demenz. Nervenarzt 78, 418–428 (2007). https://doi.org/10.1007/s00115-006-2245-1

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