Artificial Nutrition at the End of Life
Introduction
Serious illness will often compel patients, families and caregivers to make important medical choices. When a person with an illness is expected to recover and can’t swallow or properly digest food, a feeding tube may be inserted or intravenous fluids administered to help them recover. But when illness is advanced and a person is not able to recover, administering artificial nutrition (food) and hydration (fluids) will not bring them back to health, and in fact may cause discomfort.
At the end of life, it is natural to have a poor appetite. Patients report a decrease in their sense of taste and food is often no longer appealing. They may experience nausea or indigestion or have trouble swallowing. Difficulty swallowing can lead to coughing and inhalation of fluids or food into the lungs. These symptoms are the body’s way of communicating that it can no longer properly use food and fluids to sustain life.
It is important to remember that a person is dying because of the disease or illness they have and not because they can no longer eat or drink.
Making Important Decisions
- Make time to discuss your choices about end of life care with your family and other close care providers.
- Be aware that medical guidelines as well as state and federal laws agree that people have the right to refuse medical procedures and treatments at any time.
- Ask your hospice care team for information and support when making decisions about end of life care.
Benefits of Not Using Feeding Tubes and IV Fluids
- Dehydration often provides a decrease in awareness of pain and other uncomfortable symptoms. It may help contribute to a peaceful, comfortable death for many persons.
- Excess fluids that the body cannot eliminate can cause breathing difficulty. Less fluid in breathing airways can eliminate rattling and congested breath sounds.
- Reduced urine output results in less frequent need for bedpan, linen changes, and trips to the toilet and may decrease skin breakdown (bedsores).
- Feeding tubes which are inserted through the skin into the stomach can cause painful irritation. Patients sometimes experience emotional agitation from the feeling of being restrained by the tube.
How to Provide Comfort
- Some people may still enjoy very small amounts of their favorite “comfort” foods.
- A dry mouth can be helped with ice chips, sips of fluid or a moistened sponge swab. Apply lip balm to keep lips from becoming uncomfortably dry. Dehydration does not affect a dying person in the same way it affects a healthy person who feels thirsty on a hot day.
- Apply lotion to dry skin and rub any reddened areas gently if comfortable to the patient.
Offering food and drink are important parts of our culture and one of the ways we show our care. Making the decision to forgo food and fluids is an important choice and should be made with good information. Please consult your hospice care team for more information or to discuss your care concerns at the end life.
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