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Questions and Answers: Artificial Nutrition and Hydration and End of Life Decision Making

Can artificial nutrition and hydration be stopped once it has been started?

Yes. As with any other medical treatment, stopping treatment is both legally and ethically appropriate if treatment is of no benefit to the patient or it is unwanted. In fact, the law requires that treatment be stopped if the patient does not want it. If it were not possible to stop treatment once started, patients might not receive treatment that might be helpful for fear it could not be stopped later.

In practice, however, caregivers often have a more difficult time stopping a treatment that has been started than simply not starting it. Stopping a treatment makes some caregivers feel as if they are in some way "killing" the patient. It is important for health caregivers, family members, and surrogates to remember that it is the underlying disease that is causing death. The treatment is prolonging the dying process.

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Conflicts about stopping artificial nutrition and hydration often arise because the patient's wishes are not clearly known or the patient has not designated an agent to make decisions for him. Some state laws also may create obstacles to stopping treatment. In situations of uncertainty, the usual fallback position is to continue treatment. Conflicts also may occur because the patient's healthcare provider believes that it is never appropriate to stop or withhold artificial nutrition and hydration. It is important that individuals talk to their doctors and loved ones about their wishes regarding the use of artificial nutrition and hydration at the end of life so they will be honored.

Can anything be done if the doctor insists on providing artificial nutrition and hydration?

Yes. If individuals have made their wishes known, the doctor must honor those wishes or transfer their care to another doctor who will honor them. To keep this kind of conflict from developing, it is wise for people to talk with their physicians before a medical crisis arises, if possible, so they know their physician will honor their end-of-life choices.

Is it considered suicide to refuse artificial nutrition and hydration? Is it considered suicide to refuse artificial nutrition and hydration?

No. When a person is refusing life-sustaining treatment at the end of life, including artificial nutrition and hydration, it is not considered an act of suicide. A person at the end of life is dying, not by choice, but because of a particular condition or disease. Continuing treatment may delay the moment of death but cannot change the underlying condition.

WebMD Medical Reference from the National Hospice and Palliative Care Organization

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