End of Life: Artificial Nutrition and Hydration
Artificial nutrition and hydration is a medical treatment that allows a patient to receive nutrition (food) and hydration (fluids) when they are no longer able to take them by mouth. Doctors often prescribe artificial nutrition for patients recovering from surgery or illness; however, like all medical treatments, it can be helpful or harmful depending on the situation. Originally designed to provide short-term support for patients, the idea was that the patient would shortly recover and begin eating or drinking on their own. If a person is conscious and requesting fluids, these should never be denied. Ethical concerns arise when the patient has entered a permanent vegetative state or when death is imminent.
A few important facts to consider about Artificial Nutrition and Hydration:
When a person with a terminal illness begins to stop eating and drinking, it usually means that the body is beginning to stop functioning. Artificial nutrition will not bring the person back to a healthy state.
Patients do not die from starvation or dehydration, but rather from the underlying diseases.
Artificial nutrition can cause more discomfort to the dying patient, such as bloating swelling, cramps, diarrhea, and shortness of breath.
Natural dehydration rarely causes a patient suffering and may even be beneficial.
Feeding tubes are associated with an increased risk of pressure ulcers and bedsores. The ulcers heal more slowly.
The patient may feel disoriented or confused by the presence of the feeding tube. Dementia patients might try to pull out the feeding tube, causing more harm.
Artificial nutrition does not offer the same comforts that come from eating and tasting food with the mouth.
Putting fluids into a body that is slowly closing down means that the kidneys will not be able to process the fluids.
How Can Hospice Help?
Making the decision to begin, withhold, or withdraw Artificial Nutrition and Hydration can be a difficult one. The team at Hope Hospice offers support in guiding you along the process and providing comfort, symptom relief, and pain management regardless of your decision.
“Is my loved one starving?” is the question that almost every person asks as their loved one goes through the stages of dying. As the body declines due to underlying disease the intake decreases. It is natural for one to not eat or drink at the end of life. This is actually beneficial as natural dehydration causes the release of endorphins that promote comfort. It can also decrease nausea, vomiting, and congestion of the lungs. Artificial nutrition and hydration can cause the dying person to become restless. Feeding though G-tubes can cause aspiration pneumonia if person is being overfed. Thirst of the terminal ill patient who is near death can easily be managed by frequent oral care, ice chips, and moisturizing the lips. It can be hard to make the decision of stopping the artificial feeding and hydration, especially if you have not had clear instructions from your loved one. It is important to consider the quality of life versus quantity of years. The majority of Americans have a wish to die at home surrounded by their loved ones in peace and comfort. However, somehow, every fourth American ends up at the ICU plugged into machines for the last days of their lives. Our body is a miraculous thing which knows what it needs. By saying this, if a body resists intake it is best to follow its wishes. Now, every case is individual and we will talk to the family about different options. At the end, it is always the family and patient’s choice.”
“Accepting that your loved one is approaching the end-of-life is difficult. We are programmed to fix things when there is a "problem." Our ability to fix this perceived problem is comforting to us as we are able to be helpful. Unfortunately, much of our society is focused around staying "youthful." As we age and naturally decline, things do not work the way they once did. Perhaps for some time we are able to fix our ailments; however, there comes a time when we cannot. It's not easy to accept this. Questions that may be helpful for families to consider as they struggle with this question are: "What does a good death look like to you?" What will be acceptable? What does quality of life mean to you? “
-Sara (Social Worker)
“It is extremely hard to “let go and let God.” We want to see our loved ones eating and drinking; it is a sign of life. When someone is near the end these actions may make us feel better, but they don’t usually help our loved one. But God is with us, even in death. We might feel guilty by not providing hydration or nutrition, or that we are somehow “doing wrong” by our loved one. During times like these, our faith tells us to look to the promise of the resurrection and the life everlasting. While our loved one may go through an earthly death, he/she will not go through a spiritual death. We are claimed as God’s own and returned to God at death. And once we are, there is no more pain, no more suffering, and no more need to worry about hydration and nutrition, because our God is the God of life.
Source: National Hospice and Palliative Care Organization: http://www.nhpco.org/