Witnessing a loved one decline due to a terminal illness is incredibly difficult. This becomes even more emotionally taxing when families and caregivers observe a hospice patient ceasing to eat and drink as death approaches.
It’s natural for families to have numerous concerns during this sensitive time, including:
- Are we abandoning our loved one if we don’t attempt to feed them or offer fluids?
- What is the likelihood of survival for our loved one without food and water in hospice care? Specifically, How Long Can Someone Live Without Water Or Food when receiving hospice care?
- Our family traditions often center around food and drink as expressions of love and care. Are we diminishing our love if we withhold nutrition and hydration? Are we inadvertently causing our loved one to starve?
- Will the absence of food and water at the end of life cause discomfort or pain for our loved one?
- What actions can we take to ensure our loved one remains comfortable and free from suffering?
Why Hospice Care Often Involves Withholding Food and Water
Continuing to offer food and water, or considering artificial nutrition and hydration (ANH) methods—such as nasal (NG) or stomach (PEG) feeding tubes or intravenous (IV) fluids—can paradoxically complicate the dying process and introduce new health issues.
For end-of-life patients, artificial feeding can lead to distressing complications like gagging, discomfort, tube-related problems (blockages or infections), aspiration pneumonia, pressure sores, bloating, and a suffocating sensation of “drowning” or feeling “trapped.”
Furthermore, research indicates that artificial nutrition provides minimal benefit in extending the lifespan of hospice patients. For instance, studies have demonstrated that dementia patients who are tube-fed do not exhibit a significant difference in life expectancy compared to those who are carefully hand-fed.
Feeding Tubes: Considerations in Hospice Care
Hospice care is not withheld from patients who already have feeding tubes in place. The hospice team collaborates closely with the patient, family, and caregivers to determine whether to continue tube feeding. While technically a feeding tube can be removed, often the decision is made to simply discontinue its use.
Generally, feeding tubes are not initiated for patients who are terminally ill. Instead, the focus shifts to ensuring comfort and alleviating pain as the end of life nears. In exceptional situations, the hospice team may temporarily administer IV fluids to prevent dehydration or enhance comfort, but oral intake remains the primary mode of feeding and drinking when possible.
Determining When to Discontinue Feeding for a Hospice Patient
The nutritional and hydration needs of a dying patient are significantly different from those of a healthy, active individual. As the end of life approaches, the body progressively loses its capacity to digest and process food and liquids effectively. As organ systems and bodily functions gradually shut down, the requirement for nutrition or hydration diminishes, becoming minimal or even nonexistent. It is advisable to use the body’s natural decline as a guide to determine when to stop providing food and water to hospice patients.
Hospice providers prioritize creating personalized care plans in partnership with patients and their families. These plans are designed to align with the patient’s wishes and values, including open discussions about the role of artificial nutrition and hydration in end-of-life care.
Understanding the Timeline: Life Expectancy Without Food and Water in Hospice
Considering the numerous individual factors at play, it’s understandable to wonder how long can someone live without food and water in a hospice setting. When food and water intake ceases, a patient’s life expectancy can be as short as a few days. For the majority of individuals, this period without food and water typically lasts around 10 days, although in rare cases, it can extend to several weeks.
How Families and Caregivers Can Provide Support
Patient autonomy is paramount when making decisions about nutrition and hydration at the end of life. Patients who prioritize quality of life in their final moments often prefer to be free from tubes and medical equipment, allowing them to be physically close to loved ones and receive the comfort care they desire.
Family members and caregivers are vital in supporting a loved one through the dying process:
- If the patient is still able to eat or drink, offer small sips of water or other liquids, ice chips, hard candies, or very small spoonfuls of food. Pay close attention to the patient’s cues to know when to stop.
- If the patient can no longer drink, keep their lips and mouth moist using swabs, a damp washcloth, lip balm, or moisturizers.
- If the patient can no longer eat or refuses food, offer alternative forms of nurturing: engage in conversation, provide loving touch, play music, sing, read poetry, share humor, arrange pet visits, offer gentle massage, read aloud, pray together, or perform other acts of care and affection.
Creating and Honoring a Compassionate End-of-Life Care Plan
Ideally, decisions regarding end-of-life care should be made when everyone is healthy and capable of expressing their wishes. This is the appropriate time to create and share an advance directive with family and healthcare professionals.
However, in reality, these crucial decisions are often postponed until the patient is no longer able to communicate their preferences, leaving family members and the healthcare team to make these choices. Hospice professionals can offer specialized care and support concerning nutrition and hydration as death approaches:
- The hospice team will continue to focus on pain management and symptom relief.
- The family’s personal, cultural, and religious beliefs and values related to nutrition and hydration will be respected.
- Family members and caregivers will receive guidance on how to manage thirst and hunger compassionately and without artificial interventions in the patient’s final days.
- In the last weeks, days, and hours of life, families will be reassured that the patient’s decline and eventual death are a result of the underlying disease progression, not due to the natural decrease and eventual cessation of eating and drinking.
