Witnessing a loved one decline due to a serious illness is incredibly difficult. This becomes even more challenging when families and caregivers observe a hospice patient ceasing to eat and drink as they approach the end of life.
It’s essential to recognize that a dying patient’s nutritional needs are vastly different from those of someone healthy and active.
This situation often raises numerous concerns for families:
- Are we abandoning our loved one if we don’t try to feed them or offer fluids?
- In hospice care, what are the chances of survival without food and water? Specifically, how long can a hospice patient live without food and water?
- Food and drink are central to our family’s expressions of love and care. Are we diminishing our love by withholding nutrition and hydration? Are we allowing our loved one to starve?
- Will refusing food and water at the end of life cause pain or suffering for our loved one?
- What actions can we take to ensure our loved one remains comfortable and free from suffering?
Why Hospice Often Reduces or Stops Food and Water at the End of Life
Continuing to push food and water, or choosing artificial nutrition and hydration (ANH)—such as feeding tubes inserted nasally (NG) or directly into the stomach (PEG), or intravenous (IV) fluids for hydration—can actually complicate the dying process and introduce new health issues.
Patients at the end of life who receive artificial feeding may experience gagging, complications related to feeding tubes (like blockages or infections), discomfort, aspiration pneumonia (when food or liquid enters the lungs), pressure sores, bloating, and distressing sensations of “drowning” or feeling “trapped.”
Furthermore, research indicates that artificial nutrition has minimal impact on extending survival for hospice patients. For instance, studies reveal that dementia patients who are fed through tubes do not have a significantly different life expectancy compared to those who are carefully hand-fed.
The Realities of Feeding Tubes in End-of-Life Care
Hospice care will not be denied to a patient who already has a feeding tube in place. The hospice team will collaborate closely with the patient, family, and caregivers to determine whether continuing tube feeding is appropriate. While technically a feeding tube can be removed, the more common decision is to discontinue its use.
Generally, feeding tubes are not initiated for patients who are terminally ill. Instead, all necessary measures are taken to ensure comfort and alleviate pain as the end of life approaches. In limited situations, the hospice team might temporarily administer IV fluids to address dehydration or enhance comfort, but oral feeding and drinking will remain the primary focus as long as possible.
Determining When to Stop Feeding a Hospice Patient
A dying patient’s needs for food and water are fundamentally different from those of a healthy individual. As life nears its end, the body gradually loses its capacity to digest and process food and liquids efficiently. As organ systems and bodily functions slow down, the requirement for nutrition and hydration diminishes significantly, sometimes becoming negligible. It is generally recommended to observe the body’s natural decline as a guide for when to reduce or stop providing food and water to hospice patients.
VITAS Healthcare, and hospice providers in general, prioritize creating personalized care plans in partnership with patients and their families. These plans are designed to respect the patient’s preferences and values and include open discussions about the role, or lack thereof, of artificial nutrition and hydration.
How Long Can Hospice Patients Live Without Eating and Drinking?
Given the numerous individual factors at play, it’s natural to wonder how long can someone live without food when in hospice care. When a patient stops eating, death can occur relatively quickly, sometimes within just a few days. For the majority of individuals, the period without food typically lasts around 10 days. However, in some instances, it can extend to several weeks.
Alt text: Compassionate hospice care involves more than just medical treatment; it includes emotional and spiritual support, as shown through music, pet therapy, prayer, and gentle touch.
Ways Family Members and Caregivers Can Provide Comfort
Patient choice is paramount when making decisions about nutrition and hydration at the end of life. Patients who prioritize quality of life in their final days often prefer to avoid tubes and medical equipment, allowing them to be physically closer to loved ones and fully receive comfort care.
Family members and caregivers are crucial in supporting a loved one throughout the dying process:
- If the patient is still able to eat or drink, offer small sips of water or liquids, ice chips, hard candies, or very small spoonfuls of soft food. Pay close attention to the patient’s cues to know when to stop.
- If the patient can no longer drink, regularly moisten their lips and mouth with swabs, a damp washcloth, lip balm, or moisturizers to prevent dryness and discomfort.
- If the patient can no longer eat or is refusing food, focus on providing alternative forms of nourishment, such as meaningful conversations, loving physical touch, music, singing, poetry, humor, visits from beloved pets, gentle massage, reading aloud, prayers, or other expressions of care and affection.
Creating and Respecting a Compassionate End-of-Life Care Plan
Ideally, decisions about end-of-life care should be made while everyone is healthy and able to clearly communicate their wishes. This is the optimal time to create and share an advance directive with family members and healthcare professionals.
However, in reality, these crucial decisions are often postponed until the patient is no longer able to express their desires. This situation leaves family members and the healthcare team to make these difficult choices. Hospice professionals are invaluable resources, offering specialized care and support related to nutrition and hydration as death approaches.
Hospice care provides:
- Ongoing pain relief and symptom management to ensure the patient’s comfort.
- Respect for the family’s personal, cultural, and religious beliefs and values concerning nutrition and hydration.
- Education for family members and caregivers on how to compassionately manage thirst and hunger without resorting to artificial methods during the patient’s final days.
- Reassurance and understanding during the final weeks, days, and hours of life that the patient’s decline and eventual death are due to the natural progression of their underlying illness, and not from the reduced or ceased intake of food and drink.
