0
ARTICLE |

The Stengel Rule Applied to the Artificial Refeeding of Gastrostomy Drainage

Edward V. Spudis, MD
Arch Intern Med. 1995;155(2):218. doi:10.1001/archinte.1995.00430020112020.
Text Size: A A A
Published online

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

Topics

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();