Not long after a person suffers a major stroke, or other severe types of brain injury, close relatives are asked by the medical staff to serve as primary decision makers. Most decisions to be made are trivial (e.g., can we get your consent to place an intravenous line to deliver fluids?) but some of them can be extremely difficult to make. One such a difficult decision is whether or not a family should allow the medical staff to place a feeding tube in their loved one. The decision to do this is not only difficult for the family but also for the treating doctor. In fact, more often than not doctors wait longer than they should in order to postpone the issue for as long as possible, hoping that the patient will recover before such a drastic measure needs to be implemented.
You may ask yourself why not just keep using a temporary feeding tube. There are several important reasons why it is not wise to wait too long. First, there is a high incidence of infections associated with the long-term use of temporary feeding tubes. Second if your loved one is not eating because he is in a coma, depending on the severity of illness he is suffering from, it might be impossible to determine if and when he will finally wake up. This waiting period makes many families and doctors uncomfortable, and forces all people involved to think about whether this person would want his life extended by artificial feeding. At times a conclusion can be easily reached based on previous wishes expressed to family members by the patient, and which clearly delineate whether or not he or she would want a feeding tube. In some cases people have signed a living-will, specifically stating what should be, and what should not be done to them in situations of medical despair. There are some cases, however, when the decision is a no-brainer, such as when a person is simply not eating because he or she has an impaired swallowing mechanism but is otherwise in good health and on his or her way to recovery. In these cases placing a feeding tube is clearly worth it.
After a stroke temporary feeding tubes (also called naso-gastric tubes) are recommended for use up to one month, but after this time period a more permanent form of feeding should be considered to reduce the high risk of infections.