Helping Patients and Families Make Choices About Nutrition and Hydration at the End-of-Life

Mary Ann F. Schultz, RN

Disclosures

June 04, 2009

In This Article

Nutrition and Hydration in Long-term Care Settings

Among the many end-of-life issues encountered in long-term care (LTC), one that continually resurfaces is how to manage nutrition and hydration in an individual approaching the end of his or her life. In the course of my career in LTC, I have seen many families struggle with decisions surrounding the withholding of a loved one's food and fluids. The prevailing question from families, when the loved one no longer wants to eat or drink is, "Are we starving [him or her] to death?"

Coincidentally, I am dealing with this dilemma in my family. My 87-year-old mother does not have long to live. She has lost a significant amount of weight, and often refuses to eat or drink what I think she should. I must frequently remind myself that she is not, in fact, "starving," but experiencing a natural process for one who is near the end of life.

Allowing an individual to make his or her own decision about foregoing nutrition and fluids when a normal quality of life no longer exists can be difficult. So-called artificial nutrition -- feeding tubes and intravenous (IV) fluids -- is traumatic and invasive. A reasoned and thoughtful decision can be made to die, or allow another to die naturally and without these artificial means. Healthcare professionals receive very little education regarding these issues in their professional training. As healthcare professionals, it is our responsibility to educate patients and family members about artificial nutrition and hydration so that informed and satisfactory decisions can be made.

Artificial Nutrition and Hydration

Artificial nutrition and hydration are methods of maintaining life by administering IV fluids or enteral feedings. Providing fluids and nutrition by these routes is necessary when the individual can no longer eat or drink, or refuses to eat or drink. Artificial nutrition can be short term, when a return to a normal quality of life is expected, or long term, when a basic quality of life is no longer possible. Examples of the latter are a person with end-stage Alzheimer's disease, or an individual who has suffered a severe stroke, has lost total function on one side of the body, and cannot speak or swallow.

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