Ethical aspects of percutaneous endoscopic gastrostomy placement for artificial nutrition and hydratation

Of the many decisions that family members and physicians must make about medical care in patients with advanced disease and perceived poor quality of life, none is more heart-wrenching than the decision about artificial nutrition and hydratation. The endoscopist often is placed in a precarious position when percuta- neous endoscopic gastrostomy tube placement is requested in such patients. Clinical decision-making between the patient, the family and the physician should be consistent with legal and ethical prin- ciples. The purpose of this article is to provide an evaluation of med- ical and ethical issues regarding the decision on placing a percuta- neous endoscopic gastrostomy tube for various indications, as well as suggesting strategies to optimize the decision-making process. (Acta gastroenterol. belg., 2006, 69, 317-320).