What About Hunger and Thirst?
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. When caregivers see a patient decline in the ability to take food and fluids, they may feel compelled to ensure that adequate nutrition and fluid are provided. They may be afraid that their 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.
If you are faced with making the decision to withhold or withdraw artificial feedings and/or hydration, talk with the doctor about the benefits and risks of each as it pertains to the patient’s individual case. For more information on making difficult decisions, see Introduction to Difficult Choices 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
