The residents who required the highest level of feeding assistance actually consumed the greatest amount of food. It is perhaps a moot point to suggest that the personal contact and time involved in being fed by a concerned person is preferable to having formula fed through a tube. This could be a case of technology and expediency taking the place of caring human contact. Mitchell and Lawson suggest that when substitute decision-makers have not had adequate direction from their dependents, decisions should be based on the patient's best interests, by weighing the possible medical outcomes against perceived values and preferences. Quality of life and functional status were considered most relevant.
Quality of life is a very subjective judgement.
It appears that in Mitchell and Lawson's study most of the information was given and the decisions were made in the acute care setting, with the attendant atmosphere and pressures to reach decisions quickly. Rational decisions will frequently be overridden in such emotionally charged circumstances. Our technologically based and democratic society continues to advance our rights to long and healthy lives. The corollary is the need for an informed public that appreciates the responsibility that we each have to ourselves and to one another. Physicians certainly need to be informed adequately if they are to be worthy of the trust put in them by patients and proxies, but they cannot be all things to all people.