Your decision about having artificial hydration and nutrition will depend on:
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 linked to your general weakness and slowing metabolism. Some illnesses can make it hard for you to swallow or can cause nausea and vomiting. It is important to talk with your doctor about what to expect as your illness gets worse.
If you aren't able to take food or fluids by mouth, an intravenous (IV) line or feeding tube can be used to provide fluids and nutrition. An IV is a needle that is put in your vein through which fluids, liquid nutrition, and medicines can be given. A feeding tube can be either a tube placed in the stomach through the nose or surgically inserted through the belly into the stomach. The tube supplies medicines, fluids, and nutrition. You can also get artificial hydration from fluid injections into tissues under the skin.
For people with acute illness or injury, short-term use of IVs, injecting fluids under the skin, and feeding tubes can be helpful. And in some cases, long-term hydration may work well. For example, long-term hydration may help your kidneys do their job or may help you avoid some of the side effects of medicine. But for people facing a terminal illness, there may come a time when the risks of artificial nutrition and hydration outweigh the benefits.
Some people facing a terminal illness may benefit from getting IV fluids, fluids injected under the skin, or a feeding tube. For instance, these treatments may work well for illnesses that make it hard to swallow or cause nausea and vomiting.
When used the right way, artificial hydration or nutrition may increase your energy and comfort. But the benefits may not last. It is important to talk about your treatment goals with your doctor. What do you want to happen if you receive artificial hydration and nutrition? If these goals are not met, what would you want to do next?
Talk with your doctor about your illness. Ask if artificial hydration and nutrition will make your quality of life better.
All types of artificial hydration and nutrition have some risks.
Another problem that can be linked to IVs and feeding tubes is the limits they pose on activity. Being connected to tubes or an IV may limit your ability to walk or move around in a wheelchair.
If you choose not to have these treatments, you may be missing therapies that could improve the quality of the time you have left. Artificial hydration or nutrition may increase your energy and relieve symptoms of nausea and weakness.
If you are unable to speak and have not shared your wishes about artificial hydration and nutrition, your doctor or family may face some tough decisions. If you are unable to eat or drink, you may receive care that you don't want. For this reason, it's 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.
Your doctor may suggest that you receive these treatments if:
When you are diagnosed with a serious illness, you and your doctor will talk about treatment choices and how likely it is that your illness will be cured. If your illness can't be cured and if it is likely to shorten your life, your doctor may talk to you about receiving care that will keep you comfortable without making your life longer.
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 get a second opinion about your diagnosis and treatment options.
Deciding whether to have artificial hydration or nutrition is hard. If you choose these treatments, talk with your doctor. Make a plan to stop the treatments when it becomes clear to you, your family, and your doctor that treatment is not helping you. For instance, you may choose to receive an IV for a certain number of days. If you do not receive any benefit or if you have problems, the treatment will be stopped.
|Choose artificial hydration and nutrition||Don't choose artificial hydration and nutrition|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"My family is very concerned that I don't drink enough water or eat as much as I once did. We spoke to my doctor about these concerns, and she informed us that it is normal for a person to eat and drink less as their illness progresses. In fact, she told us that receiving IV fluids may be risky for me because I have heart failure. I am comfortable and do not feel hungry or thirsty. I feel IVs or an artificial feeding tube would cause more problems."
— Ada, age 77
"I have been diagnosed with ovarian cancer. The cancer causes fluid to build up in my belly, causing me to have a lot of nausea and vomiting. Because I cannot keep fluids down, IV fluids help me stay hydrated. I also receive nutritional supplements and my pain medication through an injection into my IV line. The IV is definitely making me more comfortable."
— Isabel, age 42
"My hospice workers and doctor talked to me about what to expect as my death gets closer. I had heard that not being fed is painful. I was very concerned about starving to death or becoming too thirsty. They informed me that my body will not need as much food or water as time goes on and that there are ways to keep me comfortable without tubes or IVs, like swabbing my mouth to keep it moist. They also told me that going without food is not painful since I won't be hungry as I get weaker. I prefer to be kept comfortable without IVs or an artificial feeding tube."
— Franco, age 61
"I was diagnosed with chronic leukemia several years ago. I notice that if I do not get enough fluids into my system, I become weaker. I go in to my doctor's office every few weeks to receive IV fluids. After the IV, I feel like I have more energy. My doctor has told me that a time will come when I will not feel as energetic after the IVs. He has also told me that a time may come when I develop problems from the IVs, like swelling in my feet or fluid in my lungs. My doctor, family, and I have decided to continue the IVs for as long as I see improvement. When the time comes that there is no benefit, we will stop the treatment."
— Al, age 74
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to choose artificial hydration and nutrition
Reasons not to choose artificial hydration and nutrition
I want to do whatever it takes to stay alive longer.
I don't want to be kept alive by artificial means.
I'm not ready to die.
I am ready to face my death and let my illness take its course.
I feel that this treatment can give me time to meet my life goals.
Meeting my remaining life goals is not a priority for me.
I'm not worried about the side effects of artificial hydration and nutrition.
I am worried about the side effects.
I have not yet shared my end-of-life wishes with the important people in my life.
The important people in my life know and support my end-of-life wishes.
My other important reasons:
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having artificial hydration and nutrition
NOT having artificial hydration and nutrition
1. Do your personal feelings about artificial hydration and nutrition matter when making this decision?
2. Will these treatments cure your illness?
3. Will these treatments cause any side effects?
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Shelly R. Garone, MD, FACP - Palliative Medicine|