Should I receive artificial hydration and nutrition?
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Introduction
This information will help you understand your health care choices if you are facing a life-limiting illness and are trying to decide whether to receive artificial hydration and nutrition.
Key points in making your decision
When you have been diagnosed with a potentially life-limiting illness, your doctor should talk to you about your illness, your treatment options, and the likelihood that artificial hydration, artificial nutrition, or both will increase your survival and quality of life. The benefits and risks of pursuing (or not pursuing) these treatments also should be addressed.
Your decision on whether to receive artificial hydration and nutrition will involve several factors, including:
- Your medical condition. Although the short-term use of IVs, hypodermoclysis (the injection of fluids directly into tissues beneath the skin), or an artificial feeding tube has been beneficial to people with acute illnesses, these treatments may prolong life but reduce its quality for some people facing a life-limiting illness.
- Your comfort. People react differently to artificial hydration and nutrition. Some people feel better with this treatment as they near the end of their life. For others, the fluids received through IVs or artificial feeding tubes can cause problems such as swelling in the arms and legs, fluid in the lungs, or stomach bloating. Regardless of whether you decide for or against artificial hydration or nutrition, your health professional will take measures to help you feel comfortable.
- Your beliefs about the use of artificial hydration and nutrition at the end of life. If you believe that artificial hydration, artificial nutrition, or both will prolong your life but may not improve the quality of your life, you may choose not to receive these treatments. On the other hand, you may believe that trying IV fluids, hypodermoclysis, or an artificial feeding tube may improve the quality of your remaining life. Or you may believe that food and water are basic human needs and should be artificially provided, regardless of the circumstances.
Your doctor will help you understand the risks and benefits of artificial nutrition and hydration. Put your wishes and plans in writing through an advance directive. An advance directive is a legal document that helps ensure your health care wishes will be respected if you become unable to communicate for yourself.
Medical Information
What is artificial hydration and nutrition?
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 related to your general weakness and slowing metabolism. Some illnesses are associated with swallowing difficulties or nausea and vomiting. It is important to talk to your doctor about what to expect as your illness progresses.
If you are no longer able to take food or fluids by mouth, an intravenous (IV) line or feeding tube can be used to provide fluids and artificial nutrition. An IV is a needle placed in your vein through which fluids, liquid nutritional supplements, and medicines can be given. A feeding tube can be either a tube inserted into the stomach through the nose (nasogastric tube, or NG tube) or a tube surgically inserted through the abdomen into the stomach (gastrostomy or PEG tube, or g-tube). As with an IV line, liquid nutritional supplements, fluids, and medicines can be given through a feeding tube. Artificial hydration can also be provided through hypodermoclysis, which involves the injection of fluids directly into tissues beneath the skin (subcutaneous).
For people with acute illness or injury, short-term use of IVs, hypodermoclysis, and artificial feeding tubes can be helpful, and in some cases ongoing hydration may be beneficial. For example, continuing hydration may help maintain kidney function or avoid some of the side effects of medicine. However, for people facing a life-limiting illness, there may come a time when the risks of artificial nutrition and hydration outweigh the benefits.
What are the benefits of artificial hydration and nutrition?
Some people facing a life-limiting illness may benefit from receiving IV fluids, hypodermoclysis, or an artificial feeding tube. For instance, it may be appropriate to use IV fluids, hypodermoclysis, or tube feedings for illnesses that cause nausea and vomiting or impair the ability to swallow.
When used appropriately, artificial hydration or nutrition may improve a person's energy and comfort level. However, the benefits may be temporary. It is important to talk about your treatment goals with your doctor. What do you expect to achieve if you receive IV fluids, hypodermoclysis, or artificial tube feedings?
Talk to your doctor about your illness and whether IV fluids, hypodermoclysis, or artificial tube feedings may improve the quality of your life.
What are the risks of artificial hydration and nutrition?
Both intravenous (IV) lines and artificial tube feedings have some risks.
IV lines
- You can get an infection at the site where the IV is inserted.
- To reduce the likelihood of infection, the IV site may be changed every few days. Having an IV inserted can be painful.
- As your illness progresses and death nears, it is normal for your body to not need as much food or fluid. Dehydration is a normal occurrence at this time. If IVs are started during this process, your body may not be able to handle the IV fluids. Swelling in your arms or legs may develop, or you may develop fluid in your lungs, which makes breathing more difficult.
Hypodermoclysis
- Swelling may occur around the site where the catheter is inserted.
- You may experience some pain or discomfort near the infusion site, although this is uncommon.
- You can get an infection at the site where the catheter is inserted.
- Your body may not be able to handle the additional fluids, causing fluid overloading. Other parts of your body may swell, or you may get fluid in your lungs, which makes breathing more difficult. There is an increased risk of heart failure.
Artificial feeding tubes
- Pneumonia can develop when fluid from the stomach is aspirated, or inhaled, into the lungs.
- A tube that is surgically placed into the stomach through the abdomen (gastrostomy or PEG tube, or g-tube) can become infected at the point of insertion.
- The artificial feeding tube may irritate the lining of the stomach, which occasionally can lead to the development of stomach ulcers.
- It is normal for your metabolism to slow as death approaches. If nutritional supplements are given during this time, digestive problems can develop, such as bloating, heartburn, or indigestion.
Another problem associated with IVs or artificial feeding tubes is the limits they pose on activity. Being connected to tubes may limit your ability to walk or move around in a wheelchair. Hypodermoclysis can in some cases avoid some of these limitations on movement.
What are the risks of not receiving artificial hydration and nutrition?
Artificial hydration or nutrition may improve the quality of your life by increasing your energy. In some cases, artificial hydration can decrease certain symptoms, such as nausea or weakness. If you choose not to receive these treatments, you may be missing therapies that can improve the quality of your remaining time.
If communication is not clear between you and your loved ones and doctor, and you are unable to communicate, medical treatment that does not follow your wishes may be chosen. For instance, if you do not want artificial hydration or nutrition but have not clearly communicated your wishes, IVs, hypodermoclysis, or tube feedings may be started if you are unable to take food or fluids by mouth. For this reason, it is very 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.
If you need more information, see the topic Writing an Advance Directive or Care at the End of Life.
Your Information
When you are diagnosed with a serious illness, your doctor will discuss treatment options with you, as well as how likely it is that your illness can be cured. If your illness cannot be cured and your life most likely will be shortened by the illness, your doctor may talk to you about receiving care that will help you remain comfortable without prolonging your life. 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 seek a second opinion about your diagnosis and treatment options.
In general, your choices are:
- Choose to receive IV fluids, hypodermoclysis (hydration injected under the skin), or tube feedings when you are no longer able to take food or fluids by mouth. Although artificial hydration and nutrition may prolong your life, these treatments will not cure your illness. In some cases, artificial hydration and nutrition can cause discomfort.
- Choose against receiving IV fluids, hypodermoclysis, or tube feedings when you are no longer able to take food or fluids by mouth. Your body will naturally slow down, and you will be kept comfortable until you die.
Deciding when to remove IVs, hypodermoclysis, or an artificial feeding tube can be difficult. If you choose to have artificial hydration, artificial nutrition, or both, it may be helpful to have a plan to stop them when it becomes clear to you, your family, and your doctor that you are not benefiting from the treatment. For instance, you may choose to receive an IV for a certain number of days, but if you do not receive any benefit or if you have problems with the IV, the treatment will be stopped.
The decision about whether to receive artificial hydration and nutrition takes into account your personal feelings and the medical facts.
| Reasons to receive artificial hydration and nutrition | Reasons not to receive artificial hydration and nutrition |
|---|---|
Are there other reasons you might want to receive artificial hydration and nutrition? |
Are there other reasons you might not want to receive artificial hydration and nutrition? |
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about receiving artificial hydration and nutrition. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
| I want to receive artificial hydration, artificial nutrition, or both if I am no longer able to take fluids or food by mouth. | Yes | No | Unsure |
| Artificial hydration or nutrition offers the chance of helping me meet the personal goals I have for the remainder of my life. | Yes | No | Unsure |
| The possible benefits of artificial hydration and nutrition outweigh the risks. | Yes | No | Unsure |
| Artificial hydration or nutrition offers a reasonable chance of extending my life and allowing me to resume my current lifestyle. | Yes | No | Unsure |
| Artificial hydration or nutrition offers a reasonable chance of improving my comfort. | Yes | No | Unsure |
| I have other health conditions that may impact my decision to choose artificial hydration and nutrition. | Yes | No | Unsure |
| I feel I can communicate openly and clearly with my loved ones and health professionals. | Yes | No | Unsure |
Use the following space to list any other important concerns you have about this decision.
|
|
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to receive or not receive artificial hydration or nutrition.
Check the box below that represents your overall impression about your decision.
| Leaning toward receiving artificial hydration or nutrition | Leaning toward NOT receiving artificial hydration or nutrition |
Return to the topic:
Credits
| Author | Sabra L. Katz-Wise |
| Editor | Susan Van Houten, RN, BSN, MBA |
| Associate Editor | Pat Truman |
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Specialist Medical Reviewer | Ira Byock, MD - Palliative Care |
| Last Updated | July 31, 2006 |
Print This
| Last updated: | July 31, 2006 |
|---|---|
| Author: | Sabra L. Katz-Wise |
| Reviewed By: | Adam Husney, MD - Family Medicine, Ira Byock, MD - Palliative Care |
| Editors: | Susan Van Houten, RN, BSN, MBA, Pat Truman |
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