When reading the excellent and comprehensive article "Bedside Assessment of Enteral Tube Placement: Aligning Practice with Evidence" (February), I would've liked to see a section on the ethics of feeding tube insertion. The insertion of a feeding tube should be considered a major ethical event. The patient's predetermined wishes should be addressed. A date for revisiting the decision to artificially feed should be set. Issues such as benefit versus burden, potential for improvement, and potential to cause patient distress must be considered.

An ethically trained nurse understands that the decision to insert an enteral feeding tube can have crucial implications for the patient, family, and community of caregivers. The placement of a feeding tube can also cause significant moral distress to the health care staff. Some facilities now require an ethics consult prior to long-term feeding tube insertion. I urge my colleagues to pause before every order for tube insertion and consider any alternatives that would bring dignity and care to the patient's bedside.

Anita Catlin, DNSc, FNP, FAAN

Pope Valley, CA