AANP Family Nurse Practitioner (FNP) Certification ExamPlanHard
A 78-year-old female with advanced dementia is brought to the clinic by her daughter for a routine check-up. The daughter expresses concerns about her mother's declining appetite and weight loss. The patient is no longer able to express her wishes clearly. The daughter asks about placing a percutaneous endoscopic gastrostomy (PEG) tube to ensure adequate nutrition. Which of the following ethical considerations is paramount in this situation?
- ANon-maleficence, avoiding interventions that may cause more harm than benefit.
- BJustice, ensuring equitable access to advanced medical procedures.
- CAutonomy, respecting the patient's previously expressed wishes or presumed preferences.
- DBeneficence, ensuring the patient receives all available medical interventions.
Show answer & explanationAnswer & explanation
Correct answer: A. Non-maleficence, avoiding interventions that may cause more harm than benefit.
In advanced dementia, studies have shown that PEG tube placement for feeding does not improve survival, prevent aspiration, or improve quality of life, and can often increase discomfort, agitation, and the need for restraints. Therefore, the principle of non-maleficence—avoiding harm—is paramount, as the intervention may cause more harm than benefit.
Why the other options are wrong
- B. Justice (fairness) is a general ethical principle but less directly applicable to the immediate clinical decision regarding an individual patient's feeding tube in advanced dementia.
- C. Autonomy is crucial, but the patient can no longer express wishes, and relying on presumed preferences requires clear documentation (e.g., advanced directive). Without such, non-maleficence guides the decision when potential harm outweighs unclear benefits.
- D. Beneficence (doing good) is important, but in advanced dementia, PEG tubes often don't provide benefit and can cause harm, making non-maleficence a more pressing concern.
PEG Tubes in Advanced Dementia
Percutaneous endoscopic gastrostomy (PEG) tubes in advanced dementia are generally not recommended due to lack of evidence for benefit and potential for increased harm.
- Do not improve survival, prevent aspiration pneumonia, or improve functional status.
- Can increase discomfort, agitation, and need for physical restraints.
- Focus should be on palliative care and comfort feeding.
Memory trick: Dementia Decisions: Don't Harm, Respect Choices, Seek Best Good.