Keywords
Creutzfeldt-Jakob Disease; CJD; dementia; gastrointestinal intubation; enteral nutrition; percutaneous endoscopic gastrostomy; PEG
Disciplines
Bioethics and Medical Ethics | Gastroenterology | Medical Humanities | Neurology | Palliative Care | Patient Safety | Public Health Education and Promotion
Abstract
Background
Creutzfeldt-Jakob disease (CJD) is a rapidly progressive neurodegenerative condition that is not easily diagnosed and has no curative treatments available, essentially requiring palliative measures, including tube feeding. Nonetheless, data shows that the endoscope used for percutaneous endoscopic gastrostomy (PEG) tube insertion can be a vector for CJD transmission.
Case Presentation
We discuss the case of an elderly patient diagnosed with CJD, requiring tube feeding. Multiple specialists were consulted, and they were unable to reach an agreement on the best approach. Eventually, the hospital ethics committee intervened, and the family agreed to comfort measures only. This case report sheds light on the ethical challenges surrounding the use of endoscopically assisted PEG tube placement for patients with confirmed or suspected CJD.
Conclusion
Ethical consideration for patients with dementia, especially with CJD, includes evaluating harm and benefit, considering legal and societal responsibilities, respecting autonomy, and managing transmission risks. Based on our findings, we encourage interdisciplinary collaboration when navigating complex medical decision-making for patients with human prion diseases and advanced dementia.
Recommended Citation
Habib, Toni; Mulrooney, Niamh Siobhán; Grabie, Yisroel; Maruf, Mohammad; and Kasapira, Sophia
(2025)
"Ethical Considerations of Percutaneous Endoscopic Gastrostomy Tube Placement in a Patient With Creutzfeldt-Jakob Disease and Advanced Dementia,"
HCA Healthcare Journal of Medicine: Vol. 6:
Iss.
1, Article 17.
DOI: 10.36518/2689-0216.1836
Available at:
https://scholarlycommons.hcahealthcare.com/hcahealthcarejournal/vol6/iss1/17
Included in
Bioethics and Medical Ethics Commons, Gastroenterology Commons, Medical Humanities Commons, Neurology Commons, Palliative Care Commons, Patient Safety Commons, Public Health Education and Promotion Commons