Nurses face some ethical issues when providing care to individuals with dementia, mainly relating to treatment, care, end-of-life issues, participation in research, safety, and autonomy ( Hughes & Common, 2015) . Some of the central ethical dilemmas that nurses encounter pertain to CPR, tube feeding, administration of antibiotics, antipsychotic medication, and pain medication. Tube feeding is one of the critical ethical dilemmas that I face when providing care to dementia patients. Individuals with dementia often develop difficulties with drinking and eating in the final stages of the disease, despite such individuals having access to feeding assistance. The difficulties emanate from the gradual loss of the neurologic control over the swallowing and oral phases of drinking and eating with the disease progression ( Neal & Catic, 2017) . As a result, individuals with dementia are exposed to an increased risk of aspiration pneumonia and nutritional decline. In a bid to address the feeding problems that individuals with dementia face, the percutaneous endoscopic gastronomy tube (PEG), which directly delivers hydration and nutrition to the stomach of an individual with swallowing problem, is introduced in the process of care.
The feeding tube is surrounded by some ethical issues, including denying an individual the pleasure of tasting food as well as denying the patient the relational benefits that emanate from careful hand feeding. Further, research demonstrates that tube feeding neither prevents or lowers the occurrence of aspiration pneumonia nor improve an individual's nutritional status. Finally, feeding tubes are primarily associated with increased physical restraints, which seek to prevent an individual from pulling the tubes from their abdomens or noses ( Neal & Catic, 2017) . Although it is ethically acceptable to withdraw nutrition and hydration by feeding tubes when a patient reaches the final stages of the disease and he or she can no longer swallow by mouth, I consider tube feeding essential to help such patients to stay hydrated and receive the required nutrition.
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The personal beliefs and ethical values that led me to this viewpoint resonate with the nurse's code of conduct, which requires nurses to respect the patient's autonomy and the right to treatment. Patients have the right to make decisions pertaining to the manner in which they would like to receive care; hence, before administering tube feeding, it is ethical and critical to consider the opinion of the patient by ensuring that the patient clearly understands the merits and demerits of the process ( Hanson, Ersek, Lin & Carey, 2013) . For patients who opt for tube feeding, the process helps them to access nutrition and hydration with minimal struggle since tube feeding helps in overcoming the challenges of swallowing difficulties. However, in cases where patients dislike tube feeding, oral feeding should be continued, and patients should not be denied food or hydration, despite having attained the final stage of the disease, which is incurable.
References
Hanson, L. C., Ersek, M., Lin, F. C., & Carey, T. S. (2013). Outcomes of feeding problems in advanced dementia in a nursing home population. Journal of the American Geriatrics Society , 61 (10), 1692-1697.
Hughes, J., & Common, J. (2015). Ethical issues in caring for patients with dementia. Nursing Standard , 29 (49), 42-47.
Neal, N., & Catic, A. G. (2017). Feeding Issues in Advanced Dementia. In Ethical Considerations and Challenges in Geriatrics (pp. 101-109). Springer International Publishing.
