Must we all die with a feeding tube?

[URO-RN]

Thought provoking article:

http://www.bioethics.net/articles.php?viewCat=2&articleId=62

or

http://www.msnbc.msn.com/id/4669899/

[Bill Levinson]

This is interesting; I was actually going to have a feeding tube put into my father when he stopped taking fluids and nutrition but he died (perhaps fortunately) before this could be done. I actually had a private duty aide with him who took plenty of time with breakfast and lunch but he simply stopped eating or drinking anything.

Although he was terminally ill (Lewy bodies disease, as it turned out), I assumed that lack of food and water would result in discomfort and I wanted him to be comfortable. (They were giving him fluids by IV, which might have reduced any sensation of thirst a little.) Do patients who stop eating and drinking on their own notice hunger or thirst?

[mrdoc2005]

This is interesting; I was actually going to have a feeding tube put into my father when he stopped taking fluids and nutrition but he died (perhaps fortunately) before this could be done. I actually had a private duty aide with him who took plenty of time with breakfast and lunch but he simply stopped eating or drinking anything.

Although he was terminally ill (Lewy bodies disease, as it turned out), I assumed that lack of food and water would result in discomfort and I wanted him to be comfortable. (They were giving him fluids by IV, which might have reduced any sensation of thirst a little.) Do patients who stop eating and drinking on their own notice hunger or thirst?

I personally think you would not notice the hunger or thirst because your body is trying to turn off. Granted that food and water are needed for life. I just thing that your body is fighting so hard or letting go that you would not notice.

I will admit this could just be what I want to believe. I lost my mother afew years back from kidney failure. She spent the last week of her life at home and we did all that we could to ensure comfort.

I am sorry about the loss of your father.

matt

[Quickbeam, BSN, RN]

Re: the title of this thread...take the time NOW to discuss your wishes with your family. DH and I both have all the documents done. I know that isn't a guarantee but I know what he'd want and he knows the same for me.

[Katnip, RN]

I'm not Catholic. I can't see my death or the death of anyone I loved being managed by this or any other Pope.

[leslie :-D]

Do patients who stop eating and drinking on their own notice hunger or thirst?

when your body is shutting down, it is natural to stop eating /drinking. it is a very natural and predictable sequelae of events that occur. to try and force feed someone during this process only serves to contribute to pt. discomfort, and in turn, elevates their stress hormones....it's just not natural or comfortable.

and your key words to me were "on their own"... so no, they do not notice it at all.

your body also releases endorphins when the body is in a half starved state and/or dehydrated.

to try and prolong a natural process of dying to me, is inhuman and insensitive.

leslie

[Katmae RN]

According to Jeb Bush yes we must be fed by tube. Those Bush's just love telling us all what we're gonna do.

[talaxandra]

Do patients who stop eating and drinking on their own notice hunger or thirst?

Hi Bill. I know this has been addressed already, but I'm adding my two cents anyway! Most people think that withholding nutrition and hydration is abhorent, and morally different from withholding other forms of therapy, because they see these as basic care, akin to pressure care for example.

I believe this is because they imagine what it would be like for them to have food and water withheld - they imagine being hungrier than they've ever been, thirstier than they can imagine, and to do that to someone who is dying seems barbaric.

The reality, though, is different. Elderly people often lose their appetites in the months before they die, regardless of other factors. This is so much the case that weight loss over the age of seventy is closely correlated with increased mortality. As Leslie points out, endorphin release contributes to a lack of hunger.

Similarly, the sensation of thirst is rarely present, and where it is can be alleviated by effective mouth care. In some conditions (particularly ascites and oedema), patients who have artificial hydration withheld become more comfortable, as the fluid is reabsorbed.

I have cared for many dying patients who have had neither artificial hydration or nutrition. None of those who were conscious reported hunger, all those who reported thirst were comfortable after mouth care and/or a few sips of water (less than 30ml is almost always sufficient).

Inserting an IV or subcutaneous butterfly for fluid is uncomfortable (limits movement, may be irritating, can extravasate) and not without risk. While that risk is no higher than it is for non-terminal patients, I don't think the risks in this case outweigh whatever the benefit is supposed to be.

If we decide to administer fluids this opens up other questions. First, what is the purpose? Oftentimes doctors on my unit order 24/24 hydration, which is insufficient to meet the patient's needs, so the purpose is not therapeutic. If we run sufficient fluid to meet patient needs, do we also have an obligation to make sure we're administering the right fluids? After all, nothing but normal saline could lead to the patient become hypernatremic. If we take bloods are we then obliged to correct any abnormal values?

I was recently unwell with a (nothing like terminal) chest infection. Not only did I not eat anything more than a handful of food a day (the most I managed was four strawberries in a twelve hour period), I was wholly disinterested in food. Not nauseated, just disinterested. Prior to this experience, I couldn't understand why some of my patients just can't be bothered eating anything.

[merricat]

in LTC we often had people lose their appetite after a stroke-- just stop eating (or drinking) and a week or so later they died. i have no opinion of the whole thing but that is what happened. heaven knows we kept offering. it happened with other conditions too. one woman had gangrene in her stomach-- i tried and tried to get her to eat, because that is what i was trained to do. no wonder she did not want to eat. i guess sometimes they know what they are doing when they stop eating. i was also trained to try to give them protein first (when they are being picky eaters). i question this: if they are dying, it seems like if they are gonna eat or drink, water might be more helpful towards ensuring comfort. we did have one man who would not take anything except little sips of water PO.

[Bill Levinson]

Hi Bill. I know this has been addressed already, but I'm adding my two cents anyway! Most people think that withholding nutrition and hydration is abhorent, and morally different from withholding other forms of therapy, because they see these as basic care, akin to pressure care for example.

I believe this is because they imagine what it would be like for them to have food and water withheld - they imagine being hungrier than they've ever been, thirstier than they can imagine, and to do that to someone who is dying seems barbaric.

That was indeed my perception but, based on what I have seen here, it is probably better that Dad passed on before a tube could be inserted. I was actually trying to get the doctor to certify that he had less than six months to live (so his living will would go into effect; it said he did not want his heart restarted if it stopped) but I did not want Dad to be uncomfortable in the meantime, which I thought dehydration and lack of nutrition would cause.

I can also recall being ill and not wanting to eat anything but forcing myself to drink because I knew I needed it.

[Spidey's mom, ADN, BSN, RN]

According to Jeb Bush yes we must be fed by tube. Those Bush's just love telling us all what we're gonna do.

That isn't what happened.

steph

[ktwlpn, LPN]

I recall Jeb Bush interfering with the Terri Schiavo case-maybe this is what the poster is referring to? I don't believe his opinion should matter to that case....