ARTIFICIAL NUTRITION & HYDRATION

  Decisions about artificial nutrition and hydration (ANH) are among the most  emotionally and ethically challenging in hospice care. The most difficult  dilemma in ANH is the social and psychological meaning that human beings  attach to food and water. When used in patients near the end-of-life, the  American Academy of Hospice and Palliative Medicine (AAHPM, 2010)  suggests these measures are seldom effective in preventing suffering of the  terminally ill.

  ANH is considered a medical treatment. Therefore, it can be requested or  refused by the patient. This right reflects the respect for a patient’s autonomy.  If a patient initially refuses ANH, ethical issues can arise if families or  caregivers demand ANH once the patient becomes incapacitated. One of the  major problems with hospice patients is that there is little evidence of the  beneficial effects of ANH on patient comfort. Moreover, the possible  complications of therapy discourage its use for most terminally ill patients.  This is particularly true with fluid therapy which has been reported to worsen edema and increase respiratory tract secretions, although these outcomes have not been strongly supported by research (HPNA, 2003).

  Since ANH is viewed as a medical intervention, then it should be evaluated by weighing the pros and cons of such actions in relation to the patient’s clinical outcomes. As the body begins to shut down before death, artificial tube feedings and water are not processed in the same way as before. Instead of hydrating and nourishing the patient, the fluids can cause abdominal bloating, swelling, and gastrointestinal problems that can add or intensify a patient’s discomfort. Ethically, the idea that a treatment’s benefits should outweigh its burdens is known as the principle of proportionality.

This principle can be applied to ANH the same way it is applied to other medical treatments. Therefore, if a dying patient receiving ANH suffers from its burden which outweighs the benefits of extending life, then artificial nutrition and hydration may be ethically withheld whether or not the patient will die sooner as a result of this action (Calipari, 2005).