Aspekte der künstlichen Ernährung bei demenzkranken Patienten in der Geriatrie

Definition of the problem: The discussion of the appropriateness of artificial nutrition in patients with advanced dementia seems to be solved on medical grounds. If it is taken for granted that a solid and valid moral judgement in medical practice rests on actual medical facts, then one needs to consider normative arguments more carefully if it can be shown that the common medical understanding of the connection between advanced dementia and artificial nutrition seems misleading. This includes a critical discussion of recently published empirical studies, which are used to justify the belief that tube feeding is useless for elderly patients in terms of their nutritional state, quality of life, and mortality. Arguments and Conclusion: This paper puts forward a threefold approach: (1) the interdependence of nutritional state and type and grade of dementia is shown, (2) a working model is presented that should avoid the poor outcomes reported in the recent medical literature, and (3) it is argued that the discussion cannot be grounded solely in medical facts because of the limitations of recently published medical evidence. Normative aspects should be given more weight.