Appendix: Information for Patients and Families About Artificial Nutrition and Fluids
When are artificial feeding and nutrition most appropriate?
· When people have a temporary condition that prevents swallowing, artificial fluids and nutrition can be provided until recovery.
What is involved in the procedure?
· An intravenous (IV) catheter may be placed in a vein or in the skin for fluids, or sometimes nutrition.
· Alternatively, a plastic tube called a nasogastric tube (NG tube) may be placed through the nose, down the throat, and into the stomach. It is approximately 1/8 inch in diameter. An NG tube can only be left in place temporarily.
· If feeding by this route, a more permanent feeding tube may be placed into the wall of the stomach (called a percutaneous gastrostomy [PEG] tube or G tube).
What are the benefits of artificial nutrition and fluids?
· A feeding tube may reduce hunger in someone who is hungry, but who is unable to swallow.
· IV fluids may reduce some symptoms, such as delirium. Delirium is marked by the patient becoming confused, sometimes agitated, and having fluctuations in alertness.
What are the burdens of giving artificial nutrition and fluids?
· All feeding tubes are associated with significant risk. Around 30% of patients have signs of the liquid entering the lungs. Called "aspiration," this fluid can cause coughing, pneumonia, and shortness of breath.
· Feeding tubes may feel uncomfortable. They can also block the stomach, causing pain, nausea, and vomiting.
· Tubes for food and fluids may become infected.
· Physical restraints (tying the hands down) are occasionally needed so that the patient won't remove the tube.
What happens if artificial nutrition and fluids are not administered?
· If a person is unable to take any food or fluids due to illness, he or she will eventually fall into a state much like a deep sleep. This process may take 1-3 weeks.
· Before entering the deep sleep, he or she will normally not experience any hunger, and thirst is generally easily controlled by placing ice chips in the cheeks or swabbing the mouth with liquid to keep the mouth moist.
· In a person with an advanced illness, choosing not to administer artificial hydration and nutrition generally does not hasten death.