Questions and Answers: Artificial Nutrition and Hydration and End of Life Decision Making
Will the withdrawal of artificial nutrition and hydration lead to a long and painful death?
No. For patients who are at the end of life, death normally occurs within
three to 14 days after artificial nutrition and hydration is stopped (the time
varies depending on how debilitated the patient was when treatment was
discontinued). Reports based on the observation of unconscious patients
indicate that the process is quite peaceful, and no evidence exists that they
are aware of the process. Conscious patients who are elderly or neurologically
impaired usually will slip quickly into a coma (a sleep-like state that is
inherently free of pain) and become similarly unaware.
Caregivers of dying people and patients themselves have reported that those
who are near death are seldom hungry, and if feelings of hunger occur, small
amounts of food by mouth are usually all the patient wants. The most common
complaint is dry mouth, a condition that can be alleviated by sips of water,
ice chips, lubricants for the lips, or other appropriate oral care. On rare
occasions, patients may experience twitching or muscle spasms when hydration is
withdrawn, but these symptoms can be managed easily with sedatives. Symptoms
that sometimes occur, such as severe pain or nausea, are due to the disease
itself. Supplying artificial nutrition and hydration will not alleviate these
symptoms and may even make them worse.
Spiritual and religious well-being may help improve quality of life.
It is not known for sure how spirituality and religion are related to health. Some studies show that spiritual or religious beliefs and practices create a positive mental attitude that may help a patient feel better and improve the well-being of family caregivers. Spiritual and religious well-being may help improve health and quality of life in the following ways:
Decrease anxiety, depression, anger, and discomfort.
Is there evidence that avoiding artificial nutrition and hydration contributes to a more comfortable death?
Yes. Much of this evidence is based on observations by those who have had a
great deal of experience caring for people who are dying, such as hospice
workers. They have noticed that patients who are not tube fed seem more
comfortable than those who are. Caregivers also have observed that symptoms
such as nausea, vomiting, abdominal pain, incontinence, congestion, shortness
of breath, among others, decreased when artificial nutrition and hydration were
discontinued, making the patient more comfortable. For example, patients with
pneumonia, one of the most common terminal events among elderly patients or
people with terminal illness, will not suffer as much from coughing or
shortness of breath due to excess mucous production if they are not receiving
fluids. Medical observation has found no indications that patients who have
suffered massive brain damage causing permanent unconsciousness experience any
pain when artificial nutrition and hydration is stopped.
Reports from conscious dying patients indicate that they increasingly
experience a lack of appetite and thirst. In fact, it is common for competent
hospice patients and those suffering acute illness to refuse food and water.
Dry mouth is the only commonly reported symptom, and it can be managed without
resort to tubes.
Animal studies indicate that the body responds to a lack of food by
increasing the production of natural pain relievers (endorphins). However, if
food is supplied, the body stops producing endorphins and the benefit of this
natural pain relief is lost.
Artificial nutrition and hydration is largely a 20th century technology.
Historically, coma was nature's way of relieving the suffering of people who
were dying. However, the provision of artificial nutrition and hydration may
prevent the development of this natural anesthesia in some cases.
WebMD Medical Reference from the National Hospice and Palliative Care Organization