Artificial Hydration & Nutrition Used In Hospice Care

Whether it takes place in a patient's home or in an institutional setting, hospice care in the United States and other wealthy countries often includes artificial nutrition and hydration, or food and fluids -- sometimes called assisted or medically assisted nutrition and hydration. To make the best possible decisions for yourself or a loved one, discuss the risks and benefits of using or not using any nutrition and hydration alternative with your physician and, if applicable, with your family and spiritual adviser.

End-of-Life Indications

Some hospice patients have swallowing difficulties or other problems that prevent them from taking in sufficient -- or any -- food or drink by mouth. These patients may benefit from assisted hydration and nutrition. According to the International Association for Hospice and Palliative Care, "The question is whether or not a particular ... intervention will restore or enhance the quality of life for a particular patient." For some terminally ill people, a well-chosen method of assisted nutrition and hydration accomplishes this purpose. For others -- such as those whose digestive or circulatory systems are naturally, irreversibly shutting down as death approaches -- assisted nutrition and hydration may cause more difficulties, and other forms of care may be more appropriate.

Other Indications

As of 2011, assisted nutrition and hydration help some people to recover from gastrointestinal or other surgeries. These interventions have greatly improved the life expectancies of many people with disabilities that are not imminently terminal, such as certain chronic neurological or digestive-tract illnesses. Artificial nutrition and hydration do not generally prolong the lives of terminally ill patients; however, artificial nutrition and hydration enable numerous people with disabilities to live in their communities because they, family members or visiting nurses can administer these interventions at home.

Enteral Methods

Enteral methods of assisted nutrition and hydration enter the body via the gut through a short- or long-term medical-access device. A nasogastric, or NG, tube is a narrow, flexible plastic tube that carries liquid food from the nose down through the throat into the stomach. It is usually used for a month or less. The best access device for long-term purposes is often a gastrostomy, or G, tube -- a port through the wall of the stomach. One common type is the percutaneous endoscopic gastrostomy, or PEG, tube.

Parenteral Methods

Parenteral nutrition and hydration are given intravenously. Generally used for two weeks or less, peripheral parenteral nutrition, or PPN, is given through veins not located in the chest or abdomen. Total parenteral nutrition, or TPN, is a better choice for longer-term use. Because they are highly concentrated, TPN solutions must be administered through a port into one of the larger central veins in the chest or the abdomen.

Concerns and Controversies

Assisted nutrition and hydration raise many complex ethical, legal, political and spiritual questions and conflicts. The most heated public controversies over assisted nutrition and hydration focus not on patients with imminently terminal illnesses, but people with long-term, severe disabilities of consciousness, such as Terri Schindler Schiavo, who died in 2005 after a court-ordered removal of her PEG tube.