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The Stengel Rule Applied to the Artificial Refeeding of Gastrostomy Drainage

The Stengel Rule Applied to the Artificial Refeeding of Gastrostomy Drainage Abstract Enthusiasm for arranging death with dignity has resulted in many pioneering laws describing living wills, advanced medical directives, and the value of a personal attorney for health care. A North Carolina law (G.S. 90-321, 1991) uses a typical phrase, "... without extraordinary means or artificial nutrition or hydration will succumb...," that should be of keen interest to internists. On first thought, the word artificial would seem to exclude all intravenous fluids and the nasogastric delivery of commercial formulas. But what makes the nutrition or hydration artificial? Is it the passageway or the unnatural complexity of the fluid? At what point does Ensure given by teaspoon, or plastic tablespoon, or syringe with a short plastic extension, become artificial? The addition of complex vitamins or needed electrolytes to normal saline might convert it into an artificial solution, but when speech therapists add thicket this might make an artificial gruel more natural. Since our References 1. Manigat M. Refeeding of gastrostomy drainage. JAMA . 1994;271:1886. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Stengel Rule Applied to the Artificial Refeeding of Gastrostomy Drainage

Archives of Internal Medicine , Volume 155 (2) – Jan 23, 1995

The Stengel Rule Applied to the Artificial Refeeding of Gastrostomy Drainage

Abstract

Abstract Enthusiasm for arranging death with dignity has resulted in many pioneering laws describing living wills, advanced medical directives, and the value of a personal attorney for health care. A North Carolina law (G.S. 90-321, 1991) uses a typical phrase, "... without extraordinary means or artificial nutrition or hydration will succumb...," that should be of keen interest to internists. On first thought, the word artificial would seem to exclude all intravenous fluids and the...
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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430020112020
Publisher site
See Article on Publisher Site

Abstract

Abstract Enthusiasm for arranging death with dignity has resulted in many pioneering laws describing living wills, advanced medical directives, and the value of a personal attorney for health care. A North Carolina law (G.S. 90-321, 1991) uses a typical phrase, "... without extraordinary means or artificial nutrition or hydration will succumb...," that should be of keen interest to internists. On first thought, the word artificial would seem to exclude all intravenous fluids and the nasogastric delivery of commercial formulas. But what makes the nutrition or hydration artificial? Is it the passageway or the unnatural complexity of the fluid? At what point does Ensure given by teaspoon, or plastic tablespoon, or syringe with a short plastic extension, become artificial? The addition of complex vitamins or needed electrolytes to normal saline might convert it into an artificial solution, but when speech therapists add thicket this might make an artificial gruel more natural. Since our References 1. Manigat M. Refeeding of gastrostomy drainage. JAMA . 1994;271:1886.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 23, 1995

References