Watching a loved one decline due to a serious illness is incredibly difficult. This becomes even more challenging when you notice a hospice patient, someone nearing the end of their life, stops eating and drinking. It’s natural for families to have many questions and concerns during this sensitive time. You might find yourself wondering about their comfort, their survival chances, and whether withholding food and water is truly the most compassionate approach.
Common worries include:
- Are we giving up on our loved one if we don’t encourage them to eat or drink?
- What are the chances of survival for someone in hospice who isn’t eating or drinking? Specifically, How Long Can A Person Live Without Food and water in hospice care?
- Food and drink are often how we show love and care. Does refusing food and water mean we’re withholding love, or even causing starvation?
- Will not providing food and water at the end of life cause pain or suffering?
- How can we ensure our loved one is comfortable and not in distress during this time?
Why Reduced Food and Water Intake is Normal in Hospice Care
It may seem counterintuitive, but reducing or stopping food and water intake is a natural part of the dying process. Continuing to push food and fluids, or resorting to artificial nutrition and hydration (ANH) like feeding tubes or IV fluids, can actually create more problems and discomfort for someone at the end of life.
Forcing artificial nutrition can lead to several complications. Hospice patients might experience gagging, discomfort, and complications from feeding tubes such as blockages or infections. Aspiration pneumonia, a serious lung infection caused by food or liquid entering the lungs, is also a risk. Furthermore, artificial feeding can cause bloating, pressure sores, and a distressing sensation of “drowning” or feeling “trapped.”
Importantly, research indicates that artificial nutrition offers minimal benefit for hospice patients and does not significantly extend life. Studies on dementia patients, for example, have shown that tube feeding does not improve life expectancy compared to careful hand-feeding.
The Limited Role of Feeding Tubes
Hospice care will still be provided even if a patient already has a feeding tube. The hospice team will work with the patient, family, and caregivers to decide whether continuing to use the tube is in the patient’s best interest. While removal is technically possible, often the decision is made to simply discontinue its use.
Generally, feeding tubes are not initiated for patients who are terminally ill and entering hospice care. The focus shifts to ensuring comfort and managing pain as the end of life approaches. In rare cases, a hospice team might use IV fluids temporarily for comfort or to address dehydration, but the primary approach for any intake will be by mouth, if the patient is willing and able.
Understanding the Timeline: How Long Can Someone Live Without Food?
It’s a natural question to ask: how long can a person live without food when they are in hospice care? The answer is complex and varies significantly from person to person. Once a patient stops eating, death can occur within a few days. For most individuals, the period without food lasts around 10 days, but in some instances, it can extend to several weeks.
Factors Influencing Survival Time
Several factors influence how long a person can live without food at the end of life, including:
- Hydration levels: While we are focusing on food, water intake is also crucial. Dehydration can accelerate the dying process. However, at the very end of life, the body’s need for hydration also decreases, and artificial hydration can be uncomfortable.
- Underlying health conditions: The specific illness and its progression play a significant role. Some conditions may lead to a faster decline than others.
- Individual metabolism: Each person’s body processes energy differently. Some individuals may naturally have more reserves and withstand food cessation for longer periods.
- Body composition: Individuals with more body fat may survive longer than those with less reserves.
- Overall health status prior to hospice: A person’s general health and strength before entering hospice will also influence how their body responds to reduced intake.
It’s important to remember that focusing solely on how long someone can live without food may shift attention away from the primary goal of hospice care, which is comfort and quality of life.
Providing Comfort and Care Instead of Food
Patient choice is paramount in end-of-life care, especially when it comes to nutrition and hydration. Many patients nearing the end of life prioritize quality of life over prolonging life at all costs. They often prefer to avoid invasive procedures like feeding tubes and want to remain close to their loved ones, receiving comfort and care in their final moments.
Family members and caregivers play a vital role in supporting their loved ones through this phase:
- If the patient can still eat or drink: Offer small sips of water or other liquids, ice chips, hard candies, or tiny spoonfuls of food if they are able to swallow and express interest. Always follow the patient’s cues and stop when they indicate they’ve had enough.
- If the patient can no longer drink: Keep their lips and mouth moist using swabs, a damp cloth, lip balm, or moisturizers. This can alleviate dryness and discomfort.
- If the patient refuses food or can no longer eat: Provide nourishment in other meaningful ways. Focus on conversation, gentle touch, music, singing, reading poetry, sharing humor, pet visits, gentle massage, reading aloud, prayers, or simply being present and offering loving care. These acts of compassion can be far more valuable than forced feeding.
Craft and Honor a Compassionate End-of-Life Care Plan
Ideally, discussions about end-of-life care preferences should happen when everyone is healthy and able to communicate clearly. This is the right time to create and share an advance directive with family and healthcare professionals.
However, often these important decisions are postponed until the patient is no longer able to express their wishes. In such situations, family members and the hospice care team must work together to make the most compassionate choices. Hospice professionals are experts in providing support and care related to nutrition and hydration as death approaches:
- The hospice team will continuously focus on pain relief and symptom management to ensure comfort.
- The patient’s personal, cultural, and religious beliefs and values regarding nutrition and hydration will be respected and honored.
- Family members and caregivers will receive guidance on how to compassionately manage thirst and hunger without resorting to artificial means during 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 due to the natural progression of their underlying illness, and not because of the natural decrease and eventual cessation of eating and drinking. Understanding how long a person can live without food in this context is less about a specific timeframe and more about accepting the natural course of life and focusing on comfort and love.
