SHALL WE CONTINUE GIVING TUBE FEEDING TO A DYING PATIENT?

Studies show that dying patients may spontaneously reduce their intake without experiencing hunger or thirst. This stage, called natural dehydration, offers benefits by producing a sedative effect on the brain and reducing secretions and excretions, making the dying process more tolerable.[1] In this instance, providing tube feedings can interfere with the natural course of dehydration that causes severe discomfort to patients facing imminent death. Artificial hydration tends to increase respiratory secretions that may cause aspiration. It can also cause an accumulation of fluids in the abdomen. It makes it more difficult for patients to breathe. Moreso, artificial feeding may expand the edema layer around tumors of cancer patients which contributes to worsening of pain and discomfort.[2]

All of the above factors may be helpful in assessing the administration or placement of tube feeding to other individuals with advanced pathological conditions. The use of tube feeding must always have to be evaluated in terms of the totality of a patient’s condition considering any undesirable effects and the likelihood of benefit.  We cannot just demand or refuse artificial nourishment or tube feeding without proper discernment and without asking relevant questions. The use of artificial feedings and intravenous fluids should always be assessed, taking into account their risks and benefits on patient’s overall health and condition.

In case that cessation of tube feeding is conscientiously decided, it is important that healthcare professionals inform surrogates and family members that the patient may cease eating and drinking near the end of life.  It is helpful that conversations will include instructions on keeping the patient as comfortable as possible.  Some of these interventions include giving medications to avoid irritability, applying ice chips or mouth swabs to relieve dryness, and providing a comfortable environment. These interventions give assurance and relief to family members that despite stopping tube feedings and other treatments, the care rendered to their loved ones continues.

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[1] Cleveland Clinic Department of Bioethics, Policy on Forgoing Life-sustaining or Death-prolonging Therapy, http://www.clevelandclinic.org/bioethics/policies/policyonlifesustaining/ccfcode.html.

[2] Rev. Tadeusz Pacholczyk, PhD. Making Sense of Bioethics, Are Feeding Tubes Required?

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