John C. Moskop, Ph.D.

Artificial Nutrition and Hydration
Decisions about withholding or withdrawing artificial nutrition or hydration near the end of life can pose ethical dilemmas for patients, families, and caregivers. From December 2002 to March 2003, the Subcommittee on Artificial Nutrition and Hydration of the Pitt County Memorial Hospital Medical Ethics Committee drafted a Statement on Artificial Nutrition and Hydration. The Statement is not an official medical staff or hospital policy, and is not legally or ethically binding. Rather, its purpose is 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.

Statement on Artificial Nutrition and Hydration
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 may benefit the patient by helping the patient to maintain proper nutrition, fluid and electrolyte balance. Since inadequate nutrition and hydration can result in death, artificial nutrition and hydration may also benefit the patient by supporting life. However, 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 are 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 can 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.