When a person eats and drinks, this is called nutrition and hydration, but when food or fluids are delivered by any other route this is called “artificial” nutrition and hydration. It is done everyday in hospitals to allow people
When a person eats and drinks, this is called nutrition and hydration, but when food or fluids are delivered by any other route this is called “artificial” nutrition and hydration.
It is done everyday in hospitals to allow people to recover from temporary illnesses of the intestinal tract or when a stroke or other disease causes reversible difficulty with swallowing. When the reason for not eating or drinking is a terminal illness, one that is progressive and usually leads to death, the value of artificial nutrition and hydration becomes subject to question. In spite of multiple recent studies, any benefit of artificial nutrition and hydration in these circumstances is unproven.
Often family members have great difficulty in dealing with this situation, and feel that their loved one is “starving to death” where in actuality it is the terminal disease, such as lung cancer, which is also causing a profound lack of appetite and even constant nausea. These patients are often disturbed by the smell of food cooking in the home. Others with end-stage Alzheimer’s simply refuse to eat or drink, and if feeding tubes are passed, they will usually pull them out. In the past these patients often had feeding tubes placed, and were then restrained to keep them from pulling out the tubes, this in turn led to increased agitation, pneumonia, and bed sores which negated any benefit of the nutrition and hydration. In most modern hospices, this type of feeding is discouraged, although assistance with feeding by mouth is always offered, and patients are encouraged to eat or drink whatever they can.
PEG: The PEG tube was invented in 1980 and is a tube placed directly through the tissues of abdominal wall into the stomach. For persons with a survivable illness, these can be helpful, but for people with advanced cancers or progressive brain deterioration, there are only complications such as pneumonia but little or no proven benefit to quality of life or even length of life. Individual counseling is highly indicated in most of these situations.
Intravenous Fluids: Here again multiple studies have been done to see if supplementing with fluids delivered by vein (intravenous) would lead to better or longer survival in patients with terminal diseases, but there has been no demonstrated benefit.
Instead, these end of life patients have their mouth kept moistened frequently and have medications to treat pain and other symptoms delivered by patches on the skin, or by suppository or even by medications given under the tongue or by nasal spray.
High levels of pain and nausea relief can be achieved by these methods. Sedation is only given in proportion to the patient’s need or request for sedation. Hospices do not routinely sedate patients and never participate in physician or nurse assisted death.
• For comments or questions about the Kauai Insight Column, contact: rweiner@kauaihospice.org.
