Abstract

Vijay is a forty-eight-year-old man with profound mental retardation and cerebral palsy. He uses a wheelchair, cannot speak or eat by mouth, and requires constant care. He lived in a group home for twenty-eight years. During the last year, Vijay has required two visits to the emergency room on average per month and has been hospitalized for two hundred days in total. These hospitalizations are the result of a number of painful and dangerous complications related to the gastrostomy tube that provides his nutrition. The last time he was in the hospital, doctors had to give him a peripherally inserted central catheter, or PICC line, to provide nutrition because the gastrostomy tube was no longer effective ..