By Dr. Mary Heilman, CHAS Bioethicist
[Reprint of SaskEthics, an Ethics Newsletter for Catholic Healthcare Organizations in Saskatchewan, January-February 2020]
Food. Such a wonderful thing to think about, and with winter settled in it’s hard not to spend January planning life one meal at a time. However, I’m willing to admit that might be my pregnancy talking.
Food is also the topic of many ethics consults, as patients, families and staff often struggle to make decisions regarding at risk eating and feeding tubes. One of the most common consults I receive is from staff who are struggling with the challenges of feeding a resident who is at risk of choking.
World Day of the Sick Feb. 11, 2020: Message from Pope Francis: LINK
When I am called into these consults, I usually want to explore things like whether a swallowing assessment has been completed, and whether the patient or their substitute decision-maker understands the risks of eating food by mouth. Assuming that everyone is on the same page about these items, the next topic of conversation becomes: Why is food so important? What makes it worth the risk?
From the perspective of a health care professional, food can sometimes be simplified down to its physiological value. Food is important because it gives nutrition and energy, and since there are other ways to receive these goods (i.e., through a feeding tube) it can be easy to question why anyone would eat at risk.
However, food is also important for reasons that go beyond the physical. How many of us sat down to our Christmas dinner this year and thought, “I can’t wait to receive my nutrients”? If you were anything like me, you were probably even more excited by the tastes, the traditions and the joy that comes from sharing a meal with loved ones.
In conversations with residents who choose to eat at risk, I have learned that their attachment to food is much more than physical. Eating is a social, spiritual and emotional experience that can bring back memories, calm anxieties and form connections with others. For many, it is well worth the risk to participate in this fundamental human experience.
Another reason that eating by mouth can be important is that it gives a sense of control. This is something I think we all learn as children from the moment we throw our first Brussels sprout across the room. Illness can often be a source of depression as control is slowly lost in many of areas of life, and for some the choice of which foods to eat and how to eat them can be an important expression of their dignity.
How does a medical team manage the anxiety that comes with supporting someone who is at risk of choking? Does it help to understand the person’s reasons for eating at risk? How would it feel to never be able to eat again?
On a personal note, my husband and I are expecting our first child in March, so this will be my last newsletter for a year. Keep your eyes open for the next SaskEthics from my replacement in April 2020.