Chapter 19 Palliative Care: End of Life BOX 19.6 Potential Benefits and Burdens of Artificial Nutrition and Hydration

Potential Benefits of Artificial Nutrition and Hydration ●

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Added energy and other nutrients may prolong life and give the client and family more time to do the following:

allow denial to serve as a natural coping mechanism that protects one from fear that death is nearing; provide emotional support by reducing fear of abandonment; get psychosocial and material affairs in order; allow for a significant family event to occur; improve client and family relationships; and

add confidence that “everything is being done” to prolong life as long as possible.

Prevents perceived suffering due to fear that death from dehydration and/or starvation is a painful way to die

Increases ability to recover from effects of other medical therapies Improves client’s overall sense of well-being and self-esteem

Improves nutritional status to decrease risk of infection, pressure ulcers, and aspiration pneumonia ● Nutrition (food and fluid) is obligatory if it alleviates discomfort from hunger or thirst (2,14,57). ● Fulfills moral belief that all persons should be fed

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Fulfills moral belief that artificial nutrition and hydration are basic humane care and society’s responsibil- ity to “be thy brother’s keeper”

Potential Burdens of Artificial Nutrition and Hydration ●

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Client may experience pain and physical suffering with the following tube or line insertion and usage;

uncomfortable distention, nausea, vomiting, diarrhea, possible aspiration and pneumonia, and excess stomal leakage and wound dehiscence with tube feedings;

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fluid overload, ascites, peripheral edema, pulmonary edema, thrombosis, and possible lung puncture and sepsis with total parenteral nutrition;

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restriction of activities by being tethered to an infusion apparatus; use of restraints;

increased need for catheterization in clients too weak to void large volumes; increased nasogastric and/or pulmonary secretions, which may require suctioning; increased pharyngeal secretions with increased fluid intake, resulting in death rattle;

psychological distress, including possible indignity of being kept alive beyond time life is meaningful and sadness of imposing hardships on family and friends;

➤➤ ➤➤ ➤➤ social isolation;

spiritual and moral conflict; and financial hardship.

Source: Data are from references 2, 6, 14, 36, 57, 62, and 63.

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