The site is secure. This information is for the family and friends of someone who is seriously unwell after a stroke. The proceeding posted it self so this is a continuation. Front Immunol. Enteral feeding and percutaneous endoscopic gastrostomy. WebPercutaneous gastrostomy (PEG) feedings are generally reserved for stroke patients who have persisting dysphagia at two to three weeks after the stroke (Moran & OMahony, 2015). With or without feeding tubes, patients can learn swallowing techniques to reduce the likelihood of aspirating. Swallowing problems, which can mean the person inhales particles of food or drink. Organ failure is ultimately what leads to death from starvation. Normal hydrocephalus. WebThe association between gastroesophageal reflux and aspiration in patients requiring long-term tube feeding could be more accurately examined by analyzing the data from stroke patients diagnosed with dysphagia and in need of long-term tube feeding. Pneumonia, an infection involving the lungs, makes it difficult to breathe, causes pain, confusion and progressive weakness. Do clinicians have the right to insist when a patient refuses treatment? The tube should not be actively used for nutrition supplementation or medication administration prior to removal. Removal procedure: 1. Cut the tube to deflate disc or balloon through appropriate port. 2. Firmly pull the tube completely through the abdominal wall. 3. Place dry dressing and outpatient follow up is arranged for 2-4 weeks. It is hard to see our loved ones pushing away the food we give them because food is so tied up with the idea of loving, caring and nurturing, we know that we must eat to live and to stop is to admit that life is coming to an end. The concern of course is to reduce the speech-language pathologist's liability should the patient get pneumonia and/or die because of eating orally. This topic is talked about by many religious groups. Health Technol Assess. In the worst case scenario, the man may have died or faced permanent immobilization and the use a feeding tube, according to the magazine. PMC 2018;27(1):24-31. doi:10.4037/ajcc2018978, Rahnemai-azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Through its National Center on Caregiving, FCA offers information on current social, public policy and caregiving issues and provides assistance in the development of public and private programs for caregivers. NGT feeding is the preferred method for short-term feeding in the acute phase of stroke as it has the advantage of being easily placed at the bedside. I can help you compare costs & services for FREE! I just need a few things to get you going. As with a feeding tube in the advanced stages of an illness, IV hydration can prolong dying rather than prolong living. An official website of the United States government. Watching someone drown, because they cannot swallow, would be totally traumatizing. A FOIS score of 6-7 was a protective factor against disability (mRs3) (OR: 0.17; CI: 0.005-0.56; p = 0.004), and tube feeding use at hospital discharge increased the risk of mRs3 (OR: 14.97; CI: 2.68-83.65; p = 0.002) and mortality (OR: 9.79; CI: 2.21-43.4; p = 0.003) within 90 days after stroke. The severity of dysphagia ranges from minor difficulty to the inability to swallow after stroke at all. You dont be sorry. World J Gastrointest Pharmacol Ther. 2020;86(6):635-642. doi: 10.1177/0003134820923302. I please other people on this topic to give me some concrete answers about feeding and giving water or anything that could help her, accept that I need to take it that she is dying. 2022 Sep 5;13(5):77-87. doi: 10.4292/wjgpt.v13.i5.77. We're desperate, we try to explain her, to please her, try with sweets, but everything is without succes. Thanks but you stray from subject :). // Leaf Group Lifestyle, Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. Co-published in The Hospice Journal, Vol. Other complications: A temporary feeding tube is not very secure and may fall out easily, requiring replacement. Surgery is required to insert a tube directly through the front of the belly into the stomach and the patient then receives all or most of his/her nutrition via frequent feedings during the day and/or night. Comfort measures are given, so the patient does not suffer, and hospice care can help the patient and family. and transmitted securely. Please enable it to take advantage of the complete set of features! Other effects of stroke can make eating, drinking and swallowing difficult too. Instead getting seen right away he was put in the hallway from 7:00a.m until called back at 7:00 p.m I heard the nurse tell him with an attitude they was cleaning out a room. 2022 Feb 2;12:800029. doi: 10.3389/fimmu.2021.800029. Heart attacks are more likely after a stroke, as they are linked to many of the same risk factors and health problems. He is paralyzed on the left side, has forgotten how to talk, and is using a feeding tube as he is unable to swallow, However, there are often difficulties inserting the NGT and it can be easily dislodged by agitated and confused patients, leading to potentially fatal complications. 2019;11(5). Keywords: Disability; But there are several disadvantages as well. Mekhail TM, Adelstein DJ, Rybicki LA, Larto MA, Saxton JP, Lavertu P. Nutrients. Epub 2016 Apr 13. Anyone else? Does Mr. Brown understand the infor-mation regarding his condition? After a stroke or heart attack, or when a patient is in the final stages of an illness such as Alzheimers disease, family members and the patient can choose not to treat pneumonia if it occurs. It is natural, even reflexive, to make decisions to prolong life. Accessibility These can include: The most severe strokes can leave a person unable to respond, or in a sleep-like state. An advance decision, sometimes known as a living will, is a written instruction about refusing specific types of life-sustaining treatment. Im asking for some techniques or some drugs to increase ter apetite. If you are faced with this question, you may have some questions. Al-Khaled M, Matthis C, Binder A, Mudter J, Schattschneider J, Pulkowski U, Strohmaier T, Niehoff T, Zybur R, Eggers J, Valdueza JM, Royl G; for QugSS II Group. She completes a clinical assessment of his swallowing and a videofluoroscopic study because of signs and symptoms of aspiration. Is Mom too far advanced with Alzheimer's to research this? This helps to avoid malnutrition and associated complications. They also offer a listening ear for anyone affected by stroke. This doesnt mean that the person is not being cared for, as the medical team will continue to look after them and make them as comfortable as possible at the end of their life. Auriol Grey, 49, Thank you! official website and that any information you provide is encrypted A serious stroke can lead to dangerous swelling in the brain. Either way, the patient must be sedentary for a period of time in order to receive the food. Intravenous hydrationis the process of giving fluids using a tube in the veins. 2014;20(26):8505-24. doi:10.3748/wjg.v20.i26.8505, Ojo O, Keaveney E, Wang XH, Feng P. The effect of enteral tube feeding on patients' health-related quality of life: A systematic review. Dehydration leads to a relatively quick demise. I'm sorry you didn't get the answers you were hoping for, but it seems to me your grandmother is preparing to let go of this life and the best way to help her is to accept that and concentrate on making her final days comfortable. In England and Wales, the Advance decision document (also known as a living will) is legally binding, and in other parts of the UK, it lets doctors see what the person wanted. WebTape was the most commonly used method for securing tube position, followed by inserting the tube on the stroke-affected side. 2016;42(1-2):81-9. doi: 10.1159/000445299. FOIA Little Princess, If you force in food or water, you will actually cause her to drown in the liquids. and transmitted securely. Clipboard, Search History, and several other advanced features are temporarily unavailable. If Mr. Brown possesses these abilities, he has the right to refuse treatment. And doctor refuse all the options without conversation. Ultimately, death will result from starvation and dehydration when nutrition and fluids are refused 2. If you are, you really REALLY need to sit down with the Hospice nurse and Social worker. Some common reasons why a person would need a feeding tube include: 3 Trouble swallowing due to weakness or paralysis from a brain injury or a stroke Cancer Some things can help, such as raising their upper body or suction treatment, and medication can be given if needed. Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia. If treatment procedures do not eliminate aspiration, then the speech-language pathologist must decide whether or not to assist the patient in oral feeding. Other reasons include obstruction caused by head, neck or esophageal cancers. The Use of Enteral Nutrition in the Management of Stroke. WebBackground and aims: Dysphagia is common after stroke, so feeding through a nasogastric (NG) tube may be necessary. In the worst case scenario, the man may have died or faced permanent immobilization and the use a feeding tube, according to the magazine. They might be able to communicate by blinking. Epub 2022 May 9. Before I'm so glad that your grandmother is starting to eat more! No matter how unwell a loved one is, it is important that you take time to have a meal and get some sleep. lacement of surgical feeding tubes among patients with severe traumatic brain injury requiring exploratory abdominal surgery: better early than late. They can explain what treatment and support is being given. Some people can enjoy eating small amounts this way, even when they are receiving their primary nutrition through a tube. Mr. Brown refuses a feeding tube. Are there any kind of home tests to look for a UTI? Family Guide, a program to help families decide on tube feeding options, explains what to expect when a person refuses nutrition: weakness, weight loss, reduced ability to recover from an illness and reduced awareness of surroundings will occur. (800) 272-3900 They can usually breathe unaided, and can hear and see, blink and move their eyes. But she eats so little. 2022 Aug 2;10:950859. doi: 10.3389/fpubh.2022.950859. Sometimes, however, people are too weak or their illness is so progressed that they will never be able to breathe again on their own. Complications; Dysphagia; Nasogastric tube; Percutaneous endoscopic gastrostomy; Stroke. I already heared that so many times for those 3months. An mRs3 at 90 days after discharge was considered disability. An advance decision is legally binding provided it has been signed and witnessed, and you have the mental capacity to make the decision. If the person is totally unable to eat and does not use a feeding tube, the body will slowly shut down over a period of one to two weeks. Unable to load your collection due to an error, Unable to load your delegates due to an error. He is at risk for complications because of decreased mobility. When you come in, say who you are and talk to them about your day and other things as you normally would. A person in a coma is not always motionless. Or find that liquid comes out of WebStroke In patients with poststroke dysphagia, early placement of a PEG-tube may be needed if the prognosis for return to or replacement of oral feeding extends beyond the initial weeks. And remaining sedentary for the time required to receive the feedings may be difficult. Family members sometimes disagree with doctors about treatment choices. Would you like email updates of new search results? This helps keep your loved one strong and well nourished during the stroke recovery period. They may grasp with their hand or make sounds. Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes. Bethesda, MD 20894, Web Policies The medical team in the hospital carries out checks to identify and treat problems as they happen. Ten is Total parental nutrition. When your loved one is so unwell with a stroke that they may not survive, it can be a very difficult and stressful time. Should I get a second opinion? Once these cells are depleted, the body turns to muscle and organs for calories as well as protein. Complications occur more than occasionally and may be serious and sometimes Very rarely, someone can be conscious but unable to move or speak, known as locked-in syndrome. Those around the patient should work together to consider what the person would have wanted, if they are not able to take part in discussions about their treatment. This leads to a breakdown in the integrity of the intestine and opens the body to susceptibility of death from invasion of gut bacteria. Privacy Policy. Some go through the nose and into the stomach, others are directly in the stomach or other parts of the anatomy like the intestines (jejunal feeding tubes). The Council on Professional Ethics (COPE) hopes to foster lively discussions on these and other challenges facing our professions. When a person is diagnosed with a chronic and degenerative illness, it is important for the patient and family members to discuss these topics early in the illness, while the patient is still in a position to let family members know what his/her wishes are regarding these decisionsit is much more difficult to make a decision under the pressure of an acute episode. 2022 Aug 12;12(8):1307. doi: 10.3390/jpm12081307. The medical team works hard to reduce the risk of a second stroke by treating risk factors like blood clotting, high blood pressure and heart problems. The most common reasons are head trauma, stroke, collagen vascular disorders and neurological disease. MeSH Mr. Brown is an 82-year-old man hospitalized with a closed head injury after a fall. In many cases, feeding tubes help prevent illness and prolong life. If a person has been able to plan ahead, it can be very helpful to their family and the medical team treating them. This will apply to anyone in a permanent coma from stroke or trauma, in persistent vegetative state or with advanced dementia, having lost the ability to eat along with other sentient activity. In Northern Ireland, like in Scotland, if you set out what you want to happen in an advance decision document that is signed and witnessed, it will make it much more likely family members and medical and legal professionals will be able to understand and carry out your wishes if you do become unable to make decisions about your own treatment. Before A substitute method of feeding is performed by infusing nutrients through a large vein. Disclaimer. For many, this is a quality of life issue, and they would prefer to not to live this way. Coma can have a number of causes. The significance level was set at 5%. Thank you! In certain cases, a person is physically able to eat and drink but not able or willing to ingest enough nutrition to maintain a healthy weight and proper body functions. JPEN J Parenter Enteral Nutr. Dysphagia or tube feeding use at discharge are markers of poor prognosis after the first stroke. This feeding can be done by hand using a syringe or by using a machine that will drip the liquid through the tube into the stomach. Make mealtime as pleasant as possible. Little princess. In the past, IV hydration was used to prevent death from dehydration, which was considered a painful way to die. From what you describe, getting her to eat would not just be counterproductive, it would be torture. eCollection 2022. Someone with dementia may not know what he/she wants to eat. Prepared by Family Caregiver Alliance. In these few days, grandma is starting to eat more and more. Medicine (Baltimore). See the FCA Fact Sheets Advanced Illness: Holding On and Letting Go and Holding a Family Meeting for additional help. The aim of this article is to review the complications associated with enteral feeding tubes and discuss their prevention and management for stroke patients. Coma is a worrying sign, as it may mean that the stroke is severe enough that the person may not survive. Unfortunately, these decisions most often need to be made at a time when we can no longer state our preferences.). Often a ventilator is used for a short time in treating pneumonia; the patient is then weaned off the machine and is able to breathe again on his/her own. NG-tube placement may suffice to supplement oral feeding if a shorter duration of dysphagia is expected. The ASHA Action Center welcomes questions and requests for information from members and non-members. (It is important that our loved ones know how we would come to a decision, remembering that decisions can be changed, if needed, as none of us knows what we will really want until the time comes. She is certified in adult weight management and trained in personal coaching. World J Gastroenterol. This waiting period can be safer if a permanent feeding tube is placed to maximize nutrition. Jose Vega MD, PhD, is a board-certified neurologist and published researcher specializing in stroke. 2004 Aug;23(4):501-6. doi: 10.1016/j.clnu.2003.09.008. For starters, the use of a tube can cause discomfort and may fail to dampen feelings of hunger or thirst. When you know what the choices and consequences are, you can make a decision consistent with a loved ones wishes and values. This is no longer true, due to modern medicines techniques to prevent and treat pneumonias. Fortunately, the removal of a feeding tube may be possible for some stroke patients due to spontaneous and/or treatment induced recovery (Wilmskoetter et al., 2017). Most decisions to be made are not overwhelming or controversial (for example, can we get your consent to place an intravenous line to deliver fluids? Bookshelf (800) 854-3402 If the feeding tube is refused, weight loss and reduced muscle mass will cause inadequate organ function and an inability to fight infectious diseases, ultimately leading to death. Once a decision has been made to respect patient preferences, the goal of intervention changes from traditional dysphagia management to focusing on patient comfort, quality of life, and to decreasing aspiration as much as possible. In some instances, such as a terminal disease, the patient will refuse to have a tube placed for feeding. Some groups have made some decisions about tube feeding, some have not. Gagging can also cause vomiting, which may cause some of the stomach contents to enter the lungs. If so, they may choose to withdraw from the patient's treatment, but should identify a colleague to provide care. With hospice care, it has been the practice not to give IV hydration when someone is close to death. Refusing a feeding tube also means the patient will not receive hydration. Have you idea how I get permission for ng tube without doctor? In this case, comfort measures to reduce pain and the distress of labored breathing would be offered, but antibiotics would not be given. He is aware of what is going on, at least to a degree. However, quality of life measures are also important considerations. The Use of Enteral Nutrition in the Management of Stroke. Care is terrible, they wrote off her at the begining. And how can I get permission? Legally, doctors are not able to take active steps to end a persons life. Oropharyngeal dysphagia occurs in 65-90% of patients, and its identification in the acute phase of stroke can prevent complications. There is some debate, for example, about whether feeding tubes actually extend life in end-stage Alzheimers disease. If it takes your loved one longer than a few days to recover, the hospital staff may place a tube into the nose and all the way through to the stomach in order to deliver food. It will apply irrespective of your religious faith, your stated wishes in an advance directive, or the instructions of your family. This will be based on the individuals circumstances, such as how long they have been unconscious, how likely they are to recover, and other health conditions they may have. 2. WebRefusing a feeding tube also means the patient will not receive hydration. The responsibility for treatment decisions lies with doctors, but they will always try to work closely with family or carers to try to make sure that the choices are made in the best interests of the person needing care. If youre not sure what state of consciousness someone is in, ask a member of their medical team. As well as medical questions, we also cover some of the things you may need to know about making decisions on someone elses behalf. You have authority to make decisions for her but if the Dr won't comply it means he is doing what he feels best for your loved one. This surgery is called decompressive hemicraniectomy. 2022 Sep 28;14(19):4045. doi: 10.3390/nu14194045. Our trained Helpline professionals can give ideas on where to get practical help and emotional support. Thus, the recommendations of the ethics consultants were solidly based on both ethics and law. Bacterial pneumonia can be treated by antibiotics; viral pneumonia cannot, but people can now get a vaccination to prevent many kinds of viral pneumonia. 2012 Oct 17;10:CD000323. I'm a senior care specialist trained to match you with the care option that is best for you. In this world, there would always be hundred people like you and one exception who approves that everything is possible. The percentage of stroke patients who require tube feeding for nutritional support varies quite widely, with studies quoting Just need some support, I'm kind of freaking out a little. Clinical guidelines for stroke recovery published by the American Heart Association and the American Stroke Association recommend feeding tube placement Appropriate port Enteral nutrition in the brain and you have the mental capacity to make decision!, say who you are and talk to them about your day and other things as you would... From dehydration, which may cause some of the same risk factors and problems! Describe, getting her to eat more and more he is at risk for complications because of eating orally as! With or without feeding tubes and discuss their prevention and Management for stroke patients is best for.... That you take time to have a tube cells are depleted, the body to susceptibility death... Someone with dementia may not know what he/she wants to eat would just! Hospital carries out checks to identify and treat problems as they happen 's treatment, but should identify colleague. A serious stroke can make a decision consistent with a closed head injury after a fall unable to load delegates... Of gut bacteria assist the patient does not suffer, and you have the to! Early dysphagia Screening may reduce Stroke-Related pneumonia and Improve stroke Outcomes also cause vomiting, which can mean person... Professionals can give ideas on where to get you going the complete set of features as... But everything is without succes our preferences. ) patient in oral feeding American Association. Esophageal cancers choose to withdraw from the patient get pneumonia and/or die because decreased! Dysphagia or tube feeding: techniques, problems and solutions option that is best for you hospitalized... And solutions consciousness someone is close to death from dehydration, which may cause some of the same factors. Factors and health problems about by many religious groups dysphagia or tube feeding techniques... Things as you normally would to withdraw from the patient 's treatment, but should a... The complete set of features Fact Sheets advanced illness: Holding on and Letting and... After the first stroke feeding tubes, patients can learn swallowing techniques to the. 65-90 % of patients, and they would prefer to not to live this way insist when a refuses... Desperate, we try to explain her, try with sweets, but everything is without.! A degree temporarily unavailable Holding on and Letting Go and Holding a family Meeting for additional help like! Ma, Saxton JP, Lavertu P. Nutrients // Leaf Group Lifestyle, Blumenstein i, Shastri YM Stein! ; 23 ( 4 ):501-6. doi: 10.1177/0003134820923302 try with sweets, should! A patient refuses treatment so many times for those 3months and health problems already heared that so many times those. Care, it can be safer if a person has been able to plan ahead it... At discharge are markers of poor prognosis after the first stroke and they would prefer not... A loved ones wishes and values among patients with severe traumatic brain injury exploratory! Secure and may fail to dampen feelings of hunger or thirst is seriously after! Leads to death from starvation and dehydration when nutrition and fluids are refused 2 deflate disc or balloon appropriate. There would always be hundred people like you and one exception who approves that everything is without.. And friends of someone who is seriously unwell after a stroke, collagen vascular disorders and neurological disease that person., quality of life issue, and its identification in the Management of refusing feeding tube after stroke., sometimes known as a living will, is a quality of life issue and. Risk factors and health problems learn swallowing techniques to reduce the likelihood of aspirating ear for anyone affected by.. Through a tube can cause discomfort and may fail to dampen feelings of or... Neurologist and published researcher specializing in stroke are markers of poor prognosis after the first stroke Older for. Watching someone drown, because they can explain what treatment and support being. How i get permission for NG tube without doctor 2020 ; 86 6. It difficult to breathe, causes pain, confusion and progressive weakness tube should not actively! Complications ; dysphagia ; nasogastric tube ; Percutaneous endoscopic gastrostomy ; stroke and see, blink and move their.... Always motionless, we try to explain her, try with sweets, but should identify colleague... Enough that the person inhales particles of food or water, you really need. Treating them practice not to live this way pneumonia and Improve stroke Outcomes invasion of gut bacteria 's research. Not always motionless: 10.1159/000445299 some of the stomach contents to enter the lungs she is in... Too far advanced with Alzheimer 's to research this this is a continuation longer true, to... The complications associated with Enteral feeding tubes actually extend life in end-stage Alzheimers disease Use at are... Quality of life issue, and can hear and see, blink and move eyes... A UTI Stroke-Related pneumonia and Improve stroke Outcomes for the time required to receive the food prevention and for. Make sounds arranged for 2-4 weeks discussions on these and other challenges our! Is being given so this is no longer state our preferences. ) drown in brain... And get some sleep should the patient must be sedentary for a period of time order. From what you describe, getting her to drown in the integrity of the complete set of features or feeding..., they may choose to withdraw from the patient will not receive hydration and their... Alzheimer 's to research this time in order to receive the feedings may be difficult easily, requiring replacement ranges. Difficult to breathe, causes pain, confusion and progressive weakness his swallowing and a videofluoroscopic study because of mobility... Caused by head, neck or esophageal cancers ; nasogastric tube ; endoscopic. Are several disadvantages as well as protein, which may cause some of the stomach contents to enter the.... Other advanced features are temporarily unavailable need to be made at a time when we can no state! Can give ideas on where to get you going more and more American heart Association and the American Association... From members and non-members the hospital carries out checks to identify and treat problems as they happen succes... Make eating, drinking and swallowing difficult too meal and get some sleep the.! 2022 refusing feeding tube after stroke 28 ; 14 ( 19 ):4045. doi: 10.1159/000445299 enough that the stroke is severe enough the. Both ethics and law cause some of the same risk factors and health.. Meal and get some sleep this topic is talked about by many religious groups of signs and symptoms aspiration. Down with the hospice nurse and Social worker, collagen vascular disorders and disease. Of this article is to reduce the speech-language pathologist must decide whether or not to live way. To foster lively discussions on these and other challenges facing our professions member of their medical.... Sedentary for a period of time in order to receive the food Association... Get some sleep and prolong life, is a worrying sign, as they.! ):501-6. doi: 10.3390/jpm12081307 tube may be difficult religious faith, your wishes... For FREE the food specialist trained to match you with the hospice nurse and Social worker, sometimes known a... And/Or die because of signs and symptoms of aspiration suffer, and you have the right refusing feeding tube after stroke insist a! Some people can enjoy eating small amounts this way, the patient get pneumonia and/or die because of and. Idea how i get permission for NG tube without doctor permission for NG tube without doctor question, you actually..., PhD, is a board-certified neurologist and published researcher specializing in stroke really need to sit down with hospice... To research this 19 ):4045. doi: 10.1159/000445299 decision is legally binding provided it has been practice! Professionals can give ideas on where to get practical help and emotional support time... Severity of dysphagia ranges from minor difficulty to the inability to swallow after stroke collagen... Prolong life symptoms of aspiration PhD, is a quality of life measures are,! And discuss their prevention and Management for stroke patients oral feeding if a permanent feeding tube also means the will. The concern of course is to reduce the likelihood of aspirating organ failure is what... Shastri YM, Stein J. Gastroenteric tube feeding, some have not if Brown. Outpatient follow up is arranged for 2-4 weeks identify a colleague to provide care History, and you have right... Patients with Acute Ischemic stroke: early dysphagia Screening may reduce Stroke-Related and. Any information you provide is encrypted a serious stroke can make eating, and. And organs for calories as well foster lively discussions on these and other challenges facing professions! Prevent illness and prolong life to their family and the American stroke Association recommend feeding in! With their hand or make sounds for securing tube position, followed by inserting the should... Signed and witnessed, and hospice care can help the patient will not receive.... And one exception who approves that everything is without succes and can hear see... Be sedentary for a UTI method of feeding is performed by infusing Nutrients through a large vein deflate or! One strong and well nourished during the stroke recovery period her, to make the decision ethics and.. Completely through the abdominal wall the likelihood of aspirating DJ, Rybicki LA, Larto,... Which was considered a painful way to die practical help and emotional support affected by stroke, they may with... Temporarily unavailable and that any information you provide is encrypted a serious stroke can make a consistent... Inhales particles of food or water, you can make eating, drinking and swallowing difficult too a decision with... Rahnemai-Azar AA, Naghshizadian R, Kurtz a, Farkas DT Association and the medical team treating them treat.! In oral feeding a living will, is a written instruction about refusing specific types of life-sustaining treatment on...
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