Drafted by the Subcommittee on Artificial Hydration and Nutrition
Note: This statement is intended to help physicians, patients, and their families think about difficult decisions relating to the use of artificial hydration or nutrition during end-of-life care.
During the course of an illness, a patient often loses the ability to receive, desire, or require nutrition or hydration by natural means. When a patient can no longer receive food and fluids normally, artificial nutrition or hydration are medical treatments that can benefit the patient by helping the patient to maintain proper nutrition and fluid and electrolyte balance. Since inadequate nutrition and hydration can result in death, artificial nutrition and hydration can also benefit the patient by supporting life. On the other hand, artificial nutrition or hydration can sometimes cause harm to the patient.
Although healthy people feel hunger when they are deprived of food and thirst when they are deprived of fluids, patients who are dying may no longer feel hunger or thirst. During the body's natural dying process, the body starts to shut down and the patient may lose the desire for food or fluids. Since artificial hydration and nutrition may cause harms to the patient, force-feeding a dying patient may sometimes do more harm than good.
Some people may be concerned that withholding or withdrawing artificial nutrition or hydration is the same thing as starving a patient, but this is usually not the case in a patient who is dying. When a dying patient (or his or her surrogate decision-maker) decides to forego artificial nutrition or hydration, the patient's disease is the cause of death. From a medical perspective, withholding or withdrawing artificial nutrition or hydration from a dying patient is no different from the decision to forego any other medical treatment, such as artificial ventilation, which may prolong dying.
Although artificial nutrition and hydration are medical treatments, food and fluids have a great deal of cultural and symbolic value. People associate food and fluids with love and care: feeding a person is often equated with caring for that person. However, artificial nutrition and hydration are medical treatments that have no necessary connection to caring. Patients who are not receiving artificial nutrition or hydration may still be provided with adequate care. The medical and nursing staff can still provide a great deal of palliative care for the dying patient that does not involve the administration of artificial nutrition and hydration.
The normal intake of food and fluids can also provide the patient with many psychological benefits, such as pleasure, satisfaction, comfort, and a sense of dignity and control. However, since artificial nutrition and hydration bypass the normal method of receiving food and fluids, they may not provide the patient with any of these psychological benefits. Indeed, artificial nutrition and hydration can sometimes have the opposite effect, especially when these medical treatments threaten the patient's sense of dignity and control.