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Disabilty Choices: Artifical Hydration and Nutrition

3/8/2012

13 Comments

 
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One of the most talked about choices a health care agent may have to make for someone unable to make their own medical choices is whether to keep a patient alive through artificial hydration and/or nutrition. 

If a person is unable to consume or keep down food and fluids they must be given liquids directly into their bloodstream and liquid nutrition needs to be put directly into their stomach through a feeding tube to keep them alive.  This isn’t food and drink in the way that we normally experience it.  

Hospice workers report that when a person is dying, their organs shut down, and they stop feeling hungry or thirsty.  Until that time, what makes a person feel thirsty is having a dry mouth, which is remedied by ice chips or other water in the mouth.  IV liquid won’t prevent thirst and people on feed tubes rarely would feel hungry without.  But these tools are necessary to keep them alive.

While people often take a black and white approach to these tools, the reality is that people often make different choices about them depending on the circumstances.  Most people, if otherwise healthy, would want IV fluid if they became dehydrated due to flu or other illness.  Many would want both fluids and nutrition if they were in a coma that was potentially reversible at least for a few weeks to see if they would regain consciousness.  Most of my clients indicate that they wouldn't want to be kept alive for years through these tools if they were in a permanent conscious condition.  But even if the choice changes from condition to condition, I think it is helpful if the agent understand the choice is to prolong life or not prolong life and not a choice of leaving a patient thirsty or starving as they die.


13 Comments
Andrea
4/7/2012 06:29:03 am

I'm a palliative care nurse and I have to disagree with you. Artificial hydration and nutrition at end of life does not prolong life. Most studies done indicated the opposite.
Artificial nutrition may result in aspiration pneumonia, nausea and vomiting, pulling of the tubes (either nasogastric, gastric (G tube or PEG tube) or intravenous) as well as risk of infection.
Artifical hydration at end of life can actually CAUSE discomfort:
I-ntravenous fluids can cause infiltration of the needle, pain on insertion, mobilization, redness, etc.
-Increased circulating volume causing the heart (which could already be compromised) to work harder (CHF)
-Increased gastrointestinal fluids causing nausea and vomiting
-Respiratory overload causing increased secretions and edema
-Problems with urination (Bladder retention, incontinence, kidney stones, etc.)
-With cancer patients edema around the tumour causing pain

So I don't think it is a question of prolonging life or not, but whether the body is absorbing the nutrients it would be given artificially.

Reply
Jamie Clausen
4/7/2012 11:01:54 am

Thanks for you comment! There are certainly cases where artificial hydration and nutrition can have serious negative impacts on patients and in some cases those negative reactions can shorten life. But there are also many conditions, such Permanent Vegetative Condition, where it can prolong life for many years. It also the case that many people need short term treatment for acute treatable conditions. Whether the treatment would be beneficial or not is something health care agents need to discuss with their providers. The point was even when it is helpful it usually only useful to prolong life and very rarely, if ever, reduces suffering for patients with serious, life ending conditions.

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6/23/2013 06:28:36 pm

Do you know the year in which artificial nutrition has started? However I must say that it is one of the most important findings! People suffering from various types of disabilities have always found them worthy! Perhaps that costs their life!

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he point was even when it is helpful it usually only useful to prolong life and very rarely, if ever, reduces suffering for patients with serious, life ending conditions.

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