Rethinking artificial hydration and nutrition for end-stage Alzheimer's disease patients from a bioethical point of view -- evidence based ethics

Abstract

Due to an increase in the number of patients suffering from Alzheimer's disease, issues relating to withholding and withdrawing of life-prolonging treatment (artificial hydration and nutrition) are in urgent need of discussion. In the ethical thinking, not only patient's autonomy (Value) but also scientific evidence (Fact) is important (= evidence based ethics). There are evidences in foreign countries that indicate tube feeding does not prevent aspiration pneumonia, does not prolong survival and does not reduce the risk of infection. In Japan, we do not have objective data on the efficacy of tube feeding. Artificial hydration and nutrition is implemented just for improving malnutrition without ethical thinking. To implement tube feeding appropriately for the end-stage Alzheimer's disease patients, an identification of objective evidence and prevalence of advanced directive in Japan are important.