Ethical Considerations of Percutaneous Endoscopic Gastrostomy Tube Placement in a Patient With Creutzfeldt-Jakob Disease and Advanced Dementia.

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.