Extraordinary Therapy and Social Status

Abstract

A case is presented of a boy who had a relentlessly progressive brain tumor involving the upper cervical cord. The only way to maintain nutritional support was intravenous hyperalimentation (IVH) at home, which seemed contraindicated because the boy's prognosis was considered hopeless, the family lived in an area remote from medical support, the parents had minimal or no education, and the family was in dire economic circumstances. Nevertheless, home IVH was initiated. The boy had 18 months of totally uneventful IVH, with good weight gain and a quality of life that was fully acceptable to him and his family. This case is discussed in the light of two differing perceptions of IVH: (1) as a medical intervention that can be discontinued (the currently dominant view) and (2) as a basic nutritional support. The ethnic and economic background of the patient whose case is reviewed expands the discussion to include the psychosocial