advance care planning: should i have artificial hydration and nutrition?

a time may come during the course of your illness when you may eat and drink less. the changes in your appetite and fluid intake may be linked to your general weakness and slowing metabolism. some illnesses can make it hard for you to swallow or can cause nausea and vomiting. it is important to talk with your doctor about what to expect as your illness gets worse.

if you aren't able to take food or fluids by mouth, an intravenous (i.v.) line or feeding tube can be used to provide fluids and nutrition. an i.v. is a needle that is put in your vein through which fluids, liquid nutrition, and medicines can be given. a feeding tube can be either a tube placed in the stomach through the nose or surgically inserted through the belly into the stomach. the tube supplies medicines, fluids, and nutrition. you can also get artificial hydration from fluid injections into tissues under the skin.

for people with acute illness or injury, short-term use of i.v.s, injecting fluids under the skin, and feeding tubes can be helpful. and in some cases, long-term hydration may work well. for example, long-term hydration may help your kidneys do their job or may help you avoid some of the side effects of medicine. but for people facing a terminal illness, there may come a time when the risks of artificial nutrition and hydration outweigh the benefits.

some people facing a terminal illness may benefit from getting i.v. fluids, fluids injected under the skin, or a feeding tube. for instance, these treatments may work well for illnesses that make it hard to swallow or cause nausea and vomiting.

when used the right way, artificial hydration or nutrition may increase your energy and comfort. but the benefits may not last. it is important to talk about your treatment goals with your doctor. what do you want to happen if you receive artificial hydration and nutrition? if these goals are not met, what would you want to do next?

talk with your doctor about your illness. ask if artificial hydration and nutrition will make your quality of life better.

all types of artificial hydration and nutrition have some risks.

i.v. lines and feeding tubes

• you can get an infection at the site where the i.v. is inserted.
• to lower your risk of infection, the i.v. site may be changed every few days. having an i.v. inserted can be painful.
• i.v. fluids can cause swelling in your arms and legs, or you may get fluid in your lungs that can make it hard to breathe.
• your body may not be able to handle the extra fluids. other parts of your body may swell, or you may get fluid in your lungs, which makes breathing harder.
• you may get pneumonia if you inhale fluid from your mouth (saliva) or your stomach into your lungs.
• a tube placed in your stomach through the belly can get infected at the insertion site.
• the feeding tube may irritate your stomach lining, which sometimes can lead to stomach ulcers.
• a feeding tube may cause nausea, bloating, heartburn, or an upset stomach.

another problem that can be linked to i.v.s and feeding tubes is the limits they pose on activity. being connected to tubes or an i.v. may limit your ability to walk or move around in a wheelchair.

if you choose not to have these treatments, you may be missing therapies that could improve the quality of the time you have left. artificial hydration or nutrition may increase your energy and relieve symptoms of nausea and weakness.

if you are unable to speak and have not shared your wishes about artificial hydration and nutrition, your doctor or family may face some tough decisions. if you are unable to eat or drink, you may receive care and nutrition that you don't want. for this reason, it's important to discuss your wishes about artificial hydration with your doctor and family. state your wishes clearly, and put them in writing in an advance care plan.

your doctor may suggest that you receive these treatments if:

• short-term use of artificial hydration and nutrition can help you recover from an acute illness or injury.
• you feel that artificial hydration and nutrition will improve the quality of your life.
• there is hope that there is or will soon be a cure for your condition.

when you are diagnosed with a serious illness, you and your doctor will talk about treatment choices and how likely it is that your illness will be cured. if your illness can't be cured and if it is likely to shorten your life, your doctor may talk to you about receiving care that will keep you comfortable without making your life longer.

your doctor may also talk to you about your desire to receive i.v. fluids or tube feedings when you are no longer able to take fluids or food by mouth. ask your doctor to be as specific as possible when discussing your treatment options. you may want to get a second opinion about your diagnosis and treatment options.

deciding whether to have artificial hydration or nutrition is hard. if you choose these treatments, talk with your doctor. make a plan to stop the treatments when it becomes clear to you, your family, and your doctor that treatment is not helping you. for instance, you may choose to receive an i.v. for a certain number of days. if you do not receive any benefit or if you have problems, the treatment will be stopped.