Deciding About Artificial Feeding and Artificial Hydration

When you have a serious illness, your healthcare provider will review treatment choices with you as your illness progresses. Some of these treatments help support or sustain life if your body can no longer perform certain functions on its own. Artificial feeding and artificial hydration are examples of such treatments.  These treatments supply artificial nutrition and hydration to your body if you can no longer take in food or fluids by mouth. You can receive both artificial nutrition and hydration, or just one.

How is artificial feeding and artificial hydration given?

Artificial feeding can be given in a number of ways. Each way uses a tube to send liquid food to the body. Some types of tubes include:

• Nasogastric (NG) tube. This tube is placed through the nose and down into the stomach. It sends liquid food directly to the stomach.

• Gastrostomy tube (G-tube) or percutaneous endoscopic gastrostomy tube (PEG tube). This tube is placed through a small hole in the stomach. It sends liquid food directly into the stomach.

• IV tube. This tube is placed into a vein. It sends liquid food directly into the blood vessels.

Artificial hydration is given through an IV tube.  The tube is placed into a vein.  Fluids are then sent through the tube into the body.

What are the risks of artificial feeding and artificial hydration?

Risks can include bleeding or infection at the tube site and problems with the tube.

• For artificial feeding, pneumonia, a life-threatening condition, can result when artificial nutrition goes into the lungs instead of the stomach.
• With artificial hydration, too much fluid can build up in the body. This can cause uncomfortable swelling in the arms, legs and belly. Fluid can also build up in the lungs, which can cause trouble breathing and shortness of breath.

What happens if I choose to have artificial feeding and artificial hydration?

You will receive artificial nutrition and/or hydration to help your body function. This may help you feel better and increase your quality of life. If you are near the end of your life, you may find it hard to tolerate the problems that can occur with these treatments.  In this case, your health care provider may recommend against artificial feeding and/or hydration if it is too much of a burden on your body, or if it will not prolong life or provide comfort.

What happens if I choose not to have artificial feeding and artificial hydration?

You will continue to receive comfort care. This includes measures to relieve pain and other symptoms. If you can still chew or swallow, you may want food or fluids for pleasure.  If you cannot take in any food or fluids by mouth and choose not to have artificial feeding or hydration, your body will slowly shut down. Death will likely happen within a few days or weeks. You may find it reassuring to know that most patients near the end of life do not typically feel hunger or thirst.

Dry mouth is a more common problem, which can be relieved by keeping the lips and mouth moist. Ice chips and small sips of water can also be given, if desired.  In the last days of life, dehydration may trigger the release of chemicals in the brain that can leave you with a sense of calm and well-being. This may help you pass your final hours in greater comfort.

How do I decide if I want artificial feeding and artificial hydration?

Your health care provider and other members of your health care team can tell you more about what artificial feeding and artificial hydration mean for you. If you want, you may include family and friends in these discussions. As you make your decision, here are some things to think about or ask your health care team:

• Will my illness improve? Or will it worsen? How likely is a cure?

• How will artificial feeding and/or artificial hydration affect my health? Will having the treatment change the outcome of my illness?

• What are the risks and benefits of artificial feeding and /or artificial hydration? What problems can it cause? Will I be able to live with these problems?

• How will artificial feeding and/or artificial hydration affect my comfort and quality of life?

Consider your own values or faith. Also ask for advice from those who share your values.

Note: If you’re having trouble deciding about artificial feeding, ask your healthcare provider if you can try it for a short time to see if it helps you feel better. When the trial is done, you may then choose whether to continue or stop the treatment.

How do I state my decision about artificial feeding and artificial hydration?

You can make your decision known by telling your health care provider directly. It is best to also put your treatment wishes in writing with advance directives. These are legal forms related to health care decisions. Laws about advance directives vary from state to state. Ask your health care provider about what forms are needed to make sure your wishes will be followed. Some common forms include: 

• A Health Care Power of Attorney. This form allows you to name a person(s) to make treatment decisions on your behalf when you can’t. This person is often called a health care agent, proxy, or surrogate decision maker.

• A Living Will. This form tells others the kinds of treatment you want or don’t want when you become too ill or injured to speak for yourself.

• Medical Orders for Scope of Treatment (MOST). This form is a doctor’s order and must be an original.  It is used to direct the care for those with a serious illness.  In it, your doctor can specify your choices about artificial feeding and/or artificial hydration.

Keep in mind that you can change or cancel an advance directive at any time. It is a good idea to review your decisions each time there is a change in your health or goals of care. Also be sure to tell your Health Care Power of Attorney/ agent and loved ones of any changes in your decisions.

Deciding about artificial feeding and artificial hydration for a loved one

Ideally, the decision about artificial feeding and/or hydration is made with the patient’s consent. But in some cases, the decision may fall to the patient’s Health Care Power of Attorney/agent, or other adult. If you need to decide for a loved one, start by talking to his or her health care provider. Discuss the goals of care, the benefits and burdens of the treatment on your loved one’s health. Also think about your loved one’s wishes and values. If needed, seek advice from other health care team members, like a social worker or spiritual advisor.