confused...legal to not feed patients?

[IHeartPeds87]

Okay so I am confused. A family friend has a parent in the hospital. The patient is in a coma and was on a ventilator. They pulled the ventilator out and the patient was able to breathe on his/her own.

I was under the impression that the "DNR" status means that if the patient arrests/codes, heroic measures won't be taken and they won't put him back on a ventilator even if he needs it....hence the "Do not resiscuate"

What I don't understand? There is no stomach tube and he's not getting any food or water! Won't this kill him anyway? Is that even legal? Or is there something about the situation that I don't understand?

This is a very, very old person who has lived his/her life. I am not anti the person dying but I am trying to understand, from a legal standpoint...isn't this killing him?

[elkpark]

The Terri Schiavo "case" was about the conflict between her husband (her legal next-of-kin and therefore legally authorized to make decisions about her treatment) and her parents regarding further "treatment."

Once someone is comatose (or otherwise incapable of communicating with healthcare providers), if s/he has not made her/his wishes clear previously, her/his next-of-kin is legally able to make decisions regarding treatment/care -- they have the same right to refuse treatment, including a feeding tube or IV fluids, on behalf of their family member as any of us do to refuse treatment for ourselves.

It's not about "killing" someone -- it's about not using artificial means to prolong their death, which is inevitable in this type of situation, and keeping them as comfortable as possible during that process. Tube feeding would simply prolong the death and make it more uncomfortable for the person -- not change the outcome of the situation in any way.

[dannyc12]

That's what I thought? I thought that the only way his life could "stop" was if he/she stopped it on their own...I didn't think anyone could do anything to "speed" the process up...which isn't starving someone doing that?

I'm just confused about what is legally okay?

Here's a way to think about it: Not using a g-tube is not "speeding up" anything in the situation you mention.

There are many ways we can extend someone's suffering. Individuals or their proxies are legally free to choose not to use them.

So as far as the legal question: YES, not using a g-tube is absolutely A-OK.

[IHeartPeds87]

Thank you for educating me. I was really confused. I still don't know how I feel about this topic. No wonder it is so heavily debated.

[dannyc12]

I still don't know how I feel about this topic. No wonder it is so heavily debated.

After you spend some time working with patients whose suffering is being needlessly extended by g-tubes (and there are a LOT of them), you will know exactly how you feel about this topic.

[missy--kay]

My 30 year old sister was dying in Hospice... she went 8 weeks without artificial feedings. Her husband kept trying to feed her, but she would say " My body does not need food anymore", so we as a family took that as a cue that she does not want to be fed or a feeding tube. She had a very dignified death... our family took alot of slack from other family members for that decision, but we did what we all thought was best for her.

It can be such a slippery slope, but when the family acts in the patients best interest (and not in their own), it makes the decisions much more clearer.

[ktwlpn, LPN]

Thank you for educating me. I was really confused. I still don't know how I feel about this topic. No wonder it is so heavily debated.

As a nurse you will have to try to seperate your personal feelings regarding this issue from your patients wishes.That's been one of my biggest challenges.

[NursePeace]

You will, without a doubt, feel differently about this once you start working directly with it. Not saying you will go one way or another but you'll have less gray area. I have this conversation with families all the time and not only is it a touchy subject, its hard to explain why you shouldnt artificially hydrate or feed your loved one. My grandma went Hospice a few months back, a day prior to they administered IV fluids. She died at home with my Mom, it took her body so much longer to shut down. She was miserable for 2 weeks, "actively dying". This is no way to die. Normally this process for me in my facility, would be around a day or 2. But you have to work in the situation and form your own opinion.

[Virgo_RN, BSN, RN]

Withholding artificial nutrition is NOT equivalent to "starving" someone "to death". The disease process is what is causing death, not starvation. When a person is dying, body processes slow and shut down. This includes digestion and absorption. Putting contents into the GI tract of someone who is dying can cause discomfort such as bloating, cramping, and constipation, since their GI tract function is impaired. People who are in the dying process are often not hungry. It is their body's way of telling them that they do not need to eat.

[mamamerlee, LPN]

The last few days before my Dad died, he refused to eat, saying he was not hungry. The docs wanted to put in a feeding tube, but he refused. He was very clear that he only wanted the pain to be controlled (really bad diabetic neuropathy). His kidneys were shutting down - less than minimum output. He drifted into a deep sleep and died only 3 days after his last meal. I was grateful that his pain was finally controlled.

[kfarinato]

There was an article in AJN September 2009 titled "Stopping Eating and Drinking" about this. It was a wonderful article, and very much an eyeopener to the physiologic process of the loss of desire to eat or drink in a dying person. The one point that stuck out in my mind was that dehydration can cause a calmness of sorts and its actually quite comfortable for the person. If you have or know of somewhere to get access to this article I highly suggest it.

[nep1980]

The DNR is not the same as the withholding of nutrition and fluids. The withholding of nutrition and fluids should be specified by the patient or their proxy through an advance directive. An advance directive is a legal document stating what a person would not want done if they became terminally ill, or suffered an injury that prevented them from communicating with the healthcare team, also it names the surrogate Decision Maker. When a patient is at the point where nutrition and fluids are held the most important thing is that comfort measures are being done (such as pain medication and oral care) It is not abuse or neglect it is allowing death with dignity.

[Nascar nurse, ASN, RN]

I just didn't know that was legal and I don't really understand how it is. there is a difference between "not saving a person" (DNR) and speeding up the process of death. By not feeding someone, aren't you essentially killing them?

On a related note, what does this indicate for organ donation? Won't the organs become unviable if this occurs?

I think you are confusing a DNR with a living will. In a living will, you can specify what/if any heroic measures you would like to receive. Among those would include artifical nutrition/hydration. If the patient previously stated they did not want artificial nutrition/hydration & the family agrees then what else is there to do but let the person die peacefully.