Nutrition and eating

Special diets and advanced illness
     Seriously ill people frequently have chronic conditions such as diabetes or heart disease that are known to respond well to specialized diets. Certainly if a person is healthy and active, it is wise to stick to these regimens as much as possible. But in the case of life threatening illness, there are other factors to consider.
     The American Dietetic Association has determined that quality of life can be just as important to the seriously ill person as is nutrition. Eating is not just a biological process. Food has many social, cultural, and psychological meanings as well, and these factors have a strong influence on our enjoyment of life.
     As for daily living, dieticians have determined that a restrictive diet for people with life threatening illness may not be all that helpful. If medicines can compensate for a change in eating habits, dieticians now encourage the seriously ill to add "comfort foods" to their diets. The goal of healthy eating is to affect overall health. If restrictive diets—for instance, lack of salt—are altering an ill patient’s ability to enjoy life, then the dietary regimen is not meeting its goal of overall health and well being.
     The take-home message? What an individual with a life threatening illness eats is generally not as important as how much they enjoy the experience of eating. (Return to list)

Artificial nutrition and hydration
     Today, medical technology helps us live longer, healthier lives. However, this same technology sometimes complicates the decision making process in health care, especially during a life threatening situation. One situation where making decisions may be difficult is in the case of artificial feeding and hydration (fluids).
     There are benefits and burdens in the use of artificial nutrition. For example, benefits of providing artificial nutrition and fluids (hydration) are that it allows the patient and family members more time to assess the situation, to get information, and to make informed choices. Sometimes the patient is nourished artificially until regular feeding can begin again.
     On the other hand, the burdens of providing artificial nutrition and fluids may include build-up of fluid around the heart and lungs if the person's body is not able to adequately process them.  Another burden may arise when the decision to withdraw the nutrition is made; this decision is often difficult for family members who mistakenly see this choice as ‘starving’ their loved one. In fact, this is one of the many myths about artificial nutrition.
     Below are some definitions and common myths about artificial feeding, as well as questions you may want to ask your doctor.

• Artificial feeding: Providing nutrients in liquid form through a feeding tube.
• Nasogastric tube: (also called an "NG" tube) is usually used for shorter-term treatment (for example, up to one month). It is inserted through the nose, down the esophagus, and into the stomach. Liquid nutrition is either poured or pumped into the tube intermittently by a care provider.
• Gastrostomy tube: (Also known as "PEG" tubes, GT tubes)- This tube requires a surgical procedure for placement. It is inserted through the skin into the stomach wall. Liquid nutrition flows through the tube into the stomach intermittently, or continuously by a mechanical pump. The "PEG" tube is typically used for longer periods and can be permanently placed.
• IV hydration: Fluids given through a needle typically placed in the arm. (Return to list)

Questions for discussion with your doctor

• What is the goal of this treatment? The benefits and burdens?
• Will this make my loved one better or restore their previous state of health?
• Will the procedure hurt?
• How long can my loved one survive on artificial nutrition?
• Are there alternatives to artificial nutrition?
• Can I care for my loved one at home with this tube in place?
• Can my loved one talk while the tube is in?
• Can the feeding be stopped once it is started? Who decides this?
• What happens if we decide to do nothing?

Be sure to discuss your views on this with your doctor when making this important decision. It is very important that you have enough information to make an informed choice about this treatment. (Return to list)

Refusing to eat
     With terminal diseases such as cancer, it is natural to lose one’s appetite. In fact, feeding a patient artificially (through a tube, for example) has been shown to help a tumor grow even faster! Not eating may be one of the body’s natural defense mechanisms. Forcing food is not likely to help dying patients "keep up their strength." Near the end of life the effort required to eat, digest, and eliminate simply becomes too much to handle. Loss of appetite is a natural part of the dying process. You will be doing the person you care for a favor to honor his or her wishes regarding food.
     There has been some controversy about the person's right to refuse to eat or take in fluids just as there is controversy about the rights of an individual to refuse medical treatment. If an individual near the end of life chooses not to eat or not to drink water and nature is allowed to take its course, that person will probably die within 10 to 14 days. If he or she continues to take in fluids, the dying process may be prolonged by several weeks.
     Refusing food or water during terminal illness is not like starvation. It does not cause a painful death. Quite the contrary; after a day with no food or water, the body produces a natural painkiller. The patient often loses any sensation of hunger or thirst and even seems to experience slight euphoria. Lack of fluids may also help the patient be more comfortable because it reduces symptoms such as nausea, vomiting, bloating, and diarrhea. It can help decrease the amount of fluid buildup in the lungs, which can in turn reduce the need for bothersome suctioning procedures. The only discomfort identified is a parched or dry mouth that often happens with dehydration. Lip balm for the lips and ice chips or a mouth swab dipped in water can do much to relieve the symptoms of dry mouth. (Return to list)