Artificial Feeding

What Is It?

Artificial feeding is not feeding in the sense that we normally use the word. Instead, it's a way of getting calories and nutrients into the body when a person can't eat naturally. It may involve the use of a tube inserted into the stomach through the nose, or inserted surgically through the skin and stomach wall. The tube can deliver nutrition, water and medications. Fluid and medications can also be delivered through an intravenous (IV) line. Artificially provided nutrition and water (hydration) serve different but related purposes, and are often discussed as a single topic.

What about Terminal Illness and Artificial Feeding?

If your disease is making it difficult to swallow or get food down, artificial feeding may be a good choice. By delivering the calories your body needs it can help you remain comfortable and enjoy the time you spend with family or on other pursuits.

But if there's nothing getting in the way of eating except your lack of appetite you need to look at the question of feeding and eating in another way.

Losing interest in eating is part of the body's natural process of shutting down. It is one of a number of changes that occur in circulation, breathing and other areas as the body prepares to stop its normal functions. These changes make the physical part of dying easier and more peaceful and taking in less food and water definitely contributes to that. So if you don't feel hungry and don't feel like eating, that's a signal from your body that's worth paying attention to. And if you've already started artificial feeding, you'll want to think about stopping it if it begins to cause discomfort or you feel that it's only prolonging your dying.

Those around you may take your loss of appetite as a sign that they should get food into you by any means available, but studies show that pushing calories and fluids on a dying patient doesn't extend life. In fact it can have negative effects like encouraging tumor growth in cancer patients and causing uncomfortable swelling and shortness of breath. Let your family and caregivers know that you simply don't want food and say clearly that you've made your decision so that you can reach your goal of dying well.

What Are the Drawbacks of Artificial Feeding?

	The use of a feeding tube may result in pneumonia, infection or stomach ulcer
	A patient who repeatedly removes a tube may have to be restrained to prevent injury
	Artificial feeding may interfere with the body's natural process of shutting down
	Does not prolong life, but may prolong the dying process
	Maintaining artificial feeding and fluids can make some symptoms worse

Will I Starve to Death?

Refusing artificial feeding doesn't mean you will die of starvation or die in pain. When you're not hungry and don't want to eat, you're not going to suffer from not eating. In fact, the more immediate effect of stopping tube feeding is dehydration which actually has benefits at the end of life. For example, less fluid means:

	less congestion and therefore easier breathing
	less pressure around tumors and therefore less pain
	less urination and therefore less need for toileting

People who become dehydrated near death usually experience dry mouth but not thirst. Dry mouth can easily be relieved with ice chips or small sips of water. All of this is just as true in the case of a person who is no longer conscious and able to communicate. Malnutrition is not a worry, and dehydration, when accompanied by care for minor problems like dry mouth and possible sores, may bring comfort, not suffering.

What about Families that Insist on a Feeding Tube?

Because feeding has been a symbol of life and nurturing throughout human history, withholding food might make your family feel as if they are abandoning you. So it can be hard for them to give up feeding even when it's through a tube and even when you've said you don't want it. This becomes an even bigger problem when you're no longer able to communicate. Family members may be holding on to the idea that feeding you is a way of expressing their love and caring, especially if they think that you'll "starve to death" otherwise. If you decide that you don't want artificial feeding at a point when you're no longer conscious, tell your family in advance that you don't believe it will prolong living in a way that you want. And say that you surely don't want it to prolong your dying.