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Questions & Answers: Advance Directives and End of Life Decisions

If I refuse life support, will I still receive treatment for any pain I might have?

Many people mistakenly think that by refusing aggressive medical treatments they could be refusing all medical care. This is not the case. A dying person needs medical care, but care whose goal is comfort, not cure. This often is called "palliative care."

It is not just pain medication, although pain management is an important part of palliative care. It also can include medications for depression and anxiety, or even surgery, radiation, antibiotics, or other treatments that normally are used to cure, but in this case are used to make the person more comfortable. Palliative care is care for the whole person and so may also include spiritual and social supports and well as support for those caring for the patient.

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Can I refuse artificial nutrition and hydration (tube feeding)?

Yes. Artificial nutrition and hydration (often called "tube feeding") are life-sustaining treatments, and your refusal is protected under the law. Much as a ventilator supports breathing or a dialysis machine replaces kidney function, tube feeding provides nutrition and fluid to the body.

As with other treatments, artificial nutrition and hydration can be used temporarily until the person can eat and drink again. Some people depend permanently on artificial nutrition and hydration, and still find life to be rewarding and meaningful.

On the other hand, difficulties about the use of artificial nutrition and hydration arise when patients are terminally ill or have suffered irreversible brain damage.

Is it painful to stop artificial nutrition and hydration?

No. Contrary to some claims, stopping artificial nutrition and hydration in dying, brain-damaged, or permanently unconscious patients does not result in painful death. A growing body of evidence shows that avoiding or withdrawing artificial nutrition and hydration allows a peaceful and pain-free death. Avoiding forced feeding in someone who is too sick to eat or drink is vastly different from keeping food and water away from a healthy person who is hungry and thirsty. Symptoms, such as dry mouth, can be managed with palliative care (comfort care).

WebMD Medical Reference from the National Hospice and Palliative Care Organization

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