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End-of-Life Care: Should I Have Artificial Hydration and Nutrition?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
End-of-Life Care: Should I Have Artificial Hydration and Nutrition?
Get the facts
- Choose to have artificial hydration and nutrition when you are no longer able to take food or fluids by mouth.
- Choose not to have artificial hydration and nutrition.
Key points to remember
Your decision about having artificial hydration and nutrition will depend on:
- The benefits and risks of using (or not using) these treatments. Talk with your doctor about your illness, your treatment choices, and whether artificial hydration, artificial nutrition, or both will improve your quality of life.
- Your medical condition. The short-term use of artificial hydration and nutrition can be helpful to people with short-term (acute) illnesses. But for some people facing a terminal illness, these treatments may prolong life but not improve it. These treatments will not cure your illness.
- Your comfort. People react in different ways to artificial hydration and nutrition. Some people feel better with this treatment as they near the end of life. But it can cause problems for others, such as swelling in the arms and legs, fluid in the lungs, nausea, or stomach bloating. Whether you decide for or against artificial hydration or nutrition, your doctor will take measures to help you feel comfortable.
- Your personal feelings about artificial hydration and nutrition. If you believe that artificial hydration, artificial nutrition, or both will make your life longer but not better, you may choose not to receive them. On the other hand, you may feel that these treatments will improve the quality of the time you have left. Or you may believe that food and water are basic human needs and should be provided, no matter what.
A time may come during the course of your illness when you may eat and drink less. The changes in your appetite and fluid intake may be linked to your general weakness and slowing metabolism. Some illnesses can make it hard for you to swallow or can cause nausea and vomiting. It is important to talk with your doctor about what to expect as your illness gets worse.
If you aren't able to take food or fluids by mouth, an intravenous (IV) line or feeding tube can be used to provide fluids and nutrition. An IV is a needle that is put in your vein through which fluids, liquid nutrition, and medicines can be given. A feeding tube can be either a tube placed in the stomach through the nose or surgically inserted through the belly into the stomach. The tube supplies medicines, fluids, and nutrition. You can also get artificial hydration from fluid injections into tissues under the skin.
For people with acute illness or injury, short-term use of IVs, injecting fluids under the skin, and feeding tubes can be helpful. And in some cases, long-term hydration may work well. For example, long-term hydration may help your kidneys do their job or may help you avoid some of the side effects of medicine. But for people facing a terminal illness, there may come a time when the risks of artificial nutrition and hydration outweigh the benefits.
Some people facing a terminal illness may benefit from getting IV fluids, fluids injected under the skin, or a feeding tube. For instance, these treatments may work well for illnesses that make it hard to swallow or cause nausea and vomiting.
When used the right way, artificial hydration or nutrition may increase your energy and comfort. But the benefits may not last. It is important to talk about your treatment goals with your doctor. What do you want to happen if you receive artificial hydration and nutrition? If these goals are not met, what would you want to do next?
Talk with your doctor about your illness. Ask if artificial hydration and nutrition will make your quality of life better.
All types of artificial hydration and nutrition have some risks.
IV lines and feeding tubes
- You can get an infection at the site where the IV is inserted.
- To lower your risk of infection, the IV site may be changed every few days. Having an IV inserted can be painful.
- IV fluids can cause swelling in your arms and legs, or you may get fluid in your lungs that can make it hard to breathe.
- Your body may not be able to handle the extra fluids. Other parts of your body may swell, or you may get fluid in your lungs, which makes breathing harder.
- You may get pneumonia if you inhale fluid from your mouth (saliva) or your stomach into your lungs.
- A tube placed in your stomach through the belly can get infected at the insertion site.
- The feeding tube may irritate your stomach lining, which sometimes can lead to stomach ulcers.
- A feeding tube may cause nausea, bloating, heartburn, or an upset stomach.
Another problem that can be linked to IVs and feeding tubes is the limits they pose on activity. Being connected to tubes or an IV may limit your ability to walk or move around in a wheelchair.
If you choose not to have these treatments, you may be missing therapies that could improve the quality of the time you have left. Artificial hydration or nutrition may increase your energy and relieve symptoms of nausea and weakness.
If you are unable to speak and have not shared your wishes about artificial hydration and nutrition, your doctor or family may face some tough decisions. If you are unable to eat or drink, you may receive care that you don't want. For this reason, it's important to discuss your wishes about artificial hydration with your doctor and family. State your wishes clearly, and put them in writing in an advance directive.
Your doctor may suggest that you receive these treatments if:
- Short-term use of artificial hydration and nutrition can help you recover from an acute illness or injury.
- You feel that artificial hydration and nutrition will improve the quality of your life.
- There is hope that there is or will soon be a cure for your condition.
When you are diagnosed with a serious illness, you and your doctor will talk about treatment choices and how likely it is that your illness will be cured. If your illness can't be cured and if it is likely to shorten your life, your doctor may talk to you about receiving care that will keep you comfortable without making your life longer.
Your doctor may also talk to you about your desire to receive IV fluids or tube feedings when you are no longer able to take fluids or food by mouth. Ask your doctor to be as specific as possible when discussing your treatment options. You may want to get a second opinion about your diagnosis and treatment options.
Deciding whether to have artificial hydration or nutrition is hard. If you choose these treatments, talk with your doctor. Make a plan to stop the treatments when it becomes clear to you, your family, and your doctor that treatment is not helping you. For instance, you may choose to receive an IV for a certain number of days. If you do not receive any benefit or if you have problems, the treatment will be stopped.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You get an IV line in your vein or a feeding tube in your stomach that provides fluids and artificial nutrition. Or you may receive fluid injections under your skin.
- The IV site may be changed every few days, which may be uncomfortable.
- Your ability to move around may be limited.
- The treatment may prolong your life.
- It may increase your energy and make you feel more comfortable.
- It can help you get nutrition if you have problems swallowing. And it may relieve nausea and vomiting.
- Artificial hydration and nutrition will not cure your illness.
- Problems with IV lines and feeding tubes include:
- Infection at the IV site.
- Swelling in your arms and legs, and fluid in your lungs.
- Pneumonia, if fluids are inhaled into the lungs.
- A tube irritating your nose and sinuses.
- Nausea, bloating, heartburn, and upset stomach.
- When you are no longer able to take food and fluids by mouth, your body will slow down.
- You will be kept comfortable until you die.
- As your body shuts down, death will occur naturally.
- You may miss treatments that could improve the quality of the time you have left.
- Your life may be shortened by days or weeks.
Personal stories about artificial hydration and nutrition
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
My family is very concerned that I don't drink enough water or eat as much as I once did. We spoke to my doctor about these concerns, and she informed us that it is normal for a person to eat and drink less as their illness progresses. In fact, she told us that receiving IV fluids may be risky for me because I have heart failure. I am comfortable and do not feel hungry or thirsty. I feel IVs or an artificial feeding tube would cause more problems.
Ada, age 77
I have been diagnosed with ovarian cancer. The cancer causes fluid to build up in my belly, causing me to have a lot of nausea and vomiting. Because I cannot keep fluids down, IV fluids help me stay hydrated. I also receive nutritional supplements and my pain medication through an injection into my IV line. The IV is definitely making me more comfortable.
Isabel, age 42
My hospice workers and doctor talked to me about what to expect as my death gets closer. I had heard that not being fed is painful. I was very concerned about starving to death or becoming too thirsty. They informed me that my body will not need as much food or water as time goes on and that there are ways to keep me comfortable without tubes or IVs, like swabbing my mouth to keep it moist. They also told me that going without food is not painful since I won't be hungry as I get weaker. I prefer to be kept comfortable without IVs or an artificial feeding tube.
Franco, age 61
I was diagnosed with chronic leukemia several years ago. I notice that if I do not get enough fluids into my system, I become weaker. I go in to my doctor's office every few weeks to receive IV fluids. After the IV, I feel like I have more energy. My doctor has told me that a time will come when I will not feel as energetic after the IVs. He has also told me that a time may come when I develop problems from the IVs, like swelling in my feet or fluid in my lungs. My doctor, family, and I have decided to continue the IVs for as long as I see improvement. When the time comes that there is no benefit, we will stop the treatment.
Al, age 74
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to choose artificial hydration and nutrition
Reasons not to choose artificial hydration and nutrition
I want to do whatever it takes to stay alive longer.
I don't want to be kept alive by artificial means.
I'm not ready to die.
I am ready to face my death and let my illness take its course.
I feel that this treatment can give me time to meet my life goals.
Meeting my remaining life goals is not a priority for me.
I'm not worried about the side effects of artificial hydration and nutrition.
I am worried about the side effects.
I have not yet shared my end-of-life wishes with the important people in my life.
The important people in my life know and support my end-of-life wishes.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having artificial hydration and nutrition
NOT having artificial hydration and nutrition
What else do you need to make your decision?
Check the facts
Do your personal feelings about artificial hydration and nutrition matter when making this decision?
- YesYou're right. You may feel that these treatments should be provided no matter what. Or you may feel that they won't add to your quality of life. Either way, your beliefs matter.
- NoSorry, that's not right. You may feel that these treatments should be provided no matter what. Or you may feel that they won't add to your quality of life. Either way, your beliefs matter.
- I'm not sureIt may help to go back and read "Get the Facts." You may feel that these treatments should be provided no matter what. Or you may feel that they won't add to your quality of life. Either way, your beliefs matter.
Will these treatments cure your illness?
- YesSorry, that's not right. These treatments may prolong life, but they will not cure your illness.
- NoYou're right. These treatments may prolong life, but they will not cure your illness.
- I'm not sureIt may help to go back and read "Compare Your Options." These treatments may prolong life, but they will not cure your illness.
Will these treatments cause any side effects?
- YesYou're right. These treatments can cause problems for some people, such as swelling in the arms and legs, fluid in the lungs, nausea, and bloating.
- NoSorry, that's not right. These treatments can cause problems for some people, such as swelling in the arms and legs, fluid in the lungs, nausea, and bloating.
- I'm not sureIt may help to go back and read "Get the Facts." These treatments can cause swelling in the arms and legs, fluid in the lungs, nausea, and bloating.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Shelly R. Garone, MD, FACP - Palliative Medicine|