Tube feeding in stroke patients: a medical and ethical perspective

Dysphagia, or difficulty swallowing, is a relatively common consequence following stroke, with most sources quoting rates of around 40%. The percentage of stroke patients who require tube feeding for nutritional support varies quite widely, with studies quoting rates in the acute phase from 8.5% to 29%. Since stroke patients are likely to constitute a high percentage of patients on a neurology or rehabilitation ward, neurologists and physiatrists are likely to be confronted with the sometimes challenging decision of whether and when to commence tube feeding and whether and when to discontinue it after it has begun. This decision-making process is likely to involve medical, ethical and legal considerations and the main purpose of this paper is to review these considerations and provide some practical recommendations.