Decisions about whether to withhold or withdraw medical treatment for a terminally ill person are always wrenching. Because of the enormous symbolic meaning attached to providing food and water, decisions about whether to provide artificial nutrition and hydration can be especially difficult. However, artificial nutrition and hydration should never be confused with ordinary food and water; they are very different, and the experience of the person who is receiving them is also different.

• Artificial nutrition and hydration is a medical treatment that allows a person to receive liquids and nourishment by tube. It is sometimes referred to as “tube feeding.” A chemically balanced mix of nutrients and fluids is provided by either placing a tube through the nose into the stomach (nasogastric, or NG, tube), directly into the stomach (percutaneous endoscopic gastrostomy, or PEG), or into a vein (intravenous tube, or IV).
• Artificial nutrition and hydration is given when a person cannot eat or drink to sustain life or health and is a way to bypass whatever may be preventing a person from eating or drinking. It can be given on a short-term basis (such as after surgery) or a long-term basis (such as to individuals with serious intestinal disorders, enabling them to live fairly normal lives).
• Legally, artificial nutrition and hydration is a medical treatment that may be refused like any other treatment. Any patient who has the ability to make decisions can decide whether or not this treatment is wanted. However, if the patient does not have the ability to decide, states have different requirements about how this treatment may be refused.
• Unlike ordinary eating and drinking, artificial nutrition and hydration does not offer the sensory rewards, social interaction and comforts that come from the pleasure, taste and texture of food and liquids. Doctors and nurses—not patients themselves—control how much will be “eaten.”
• Although it cannot reverse the condition or change the course of the disease, artificial nutrition and hydration is frequently given to people with irreversible neurological disorders, such as advanced Alzheimer's disease or severe stroke. Recent studies find that this treatment does little to enable these patients to live longer and, in fact, can be a source of additional risks that can shorten life.
• Serious potential side effects of artificial nutrition and hydration are infections, breathing difficulties caused by fluid overload, and pneumonia caused by inhaling the “feed” into the lungs.
• Patients suffering from mental confusion can become anxious about the tubes' presence, try to pull them out and end up in restraints. Restraints can have a serious negative effect on a patient's mental state and ability to interact or to perform even the smallest activities, such as changing position in bed.
• Refusal of food and water is a natural part of the dying process. Caregivers of dying people and patients themselves have reported that those near death are seldom hungry and will naturally want less and less to eat or drink. Dry mouth, the most common complaint, can be relieved by small sips of water, ice chips, lubricants for the lips or other oral care.
• Those who are experienced in caring for the dying, such as hospice workers, have noticed that patients who are not tube-fed seem more comfortable than those who are. Symptoms such as nausea, vomiting, abdominal pain, loss of bladder control and shortness of breath frequently decrease when artificial nutrition and hydration are discontinued.
• A study of patients dying of cancer found that few felt hungry or thirsty and these symptoms were easily managed. It concluded that food and fluid administration beyond the specific requests of patients is unlikely to make the patient any more comfortable.
• For patients at the end of life, death normally occurs within three to 14 days after artificial nutrition and hydration is stopped. Those who have observed unconscious patients have noted that the process is peaceful and that patients show no signs of pain or discomfort.
• Artificial nutrition and hydration is largely a 20th century technology. Historically, coma was nature's way of relieving the suffering of dying people. Providing artificial nutrition and hydration may prevent the development of this natural anesthesia in some cases.
• Non-medical issues can be important aspects of decisions about providing artificial nutrition and hydration. Some people, for personal or religious convictions, believe that nutrition and fluids always must be given no matter what the condition of the patient, the expected benefit or how much the patient may be suffering.

Editor's Note: This article was originally published on www.lastacts.org, the Web site for Last Acts, formerly a national program of the Robert Wood Johnson Foundation. Be advised that the content of this article might be dated or inaccurate. The Foundation is reprinting the article here as a matter of general and historical interest.