Many patients and their families are concerned about hunger and thirst at the end of life. Many wonder if the patient should be receiving intravenous fluids or tube feedings. In most cases, the risks of artificial nutrition and hydration outweigh any benefits.
More About Artificial Nutrition and Hydration
After explaining the benefits and risks of artificial nutrition to my patients, I’m often asked, “But won’t he be hungry? I don’t want to see him suffer!” Providing food and fluids is fundamental to the role of caregiver. As a caregiver, when you see your patient unable to eat or drink, you might feel compelled to make sure adequate nutrition and fluid are provided. You might be afraid that your loved one is going to “starve” to death or die of dehydration.
It is important to understand that loss of appetite and weight loss is a normal part of the dying process. It is gradual for some and quite sudden for others -- but nearly all patients with a life-limiting illness stop eating and drinking at some point. Patients and caregivers have reported that hunger at this point is a non-issue. Patients are just not hungry at the end of life.
Thirst may occur but studies have shown that IV hydration isn’t effective in alleviating thirst much, if at all. Good oral hygiene, using oral swabs and lubricants is usually adequate to relieve dry mouth. Other symptoms of dehydration, such as muscle spasms, are rare and can be treated with sedatives if they occur.
It's important to keep in mind that your patient or loved one is not going to die of starvation or dehydration. Your patient will die from their underlying disease or condition.
If you are faced with making the decision to withhold or withdraw artificial feedings and/or hydration, talk with your patient's doctor about the benefits and risks of each one as it pertains to your patient’s individual case. For more information on making difficult decisions, see Making Difficult Health Care Decisions: Goals of Care and Deciding to Withhold or Withdraw Life Support
Sources:
20 Common Problems End of Life Care.B. Kinzbrunner, N.Weinreb, J. Policzer
HPNA Policy Statement Artificial Nutrition and Hydration in End of Life Care
