Help: Address artificial nutrition and hydration


What should I say regarding artificial nutrition and hydration?
This section contains information on:
Overview What is artificial nutrition and hydration Should I list specific instructions or limitations in my health care proxy? Types of feeding and hydration
Overview
In New York State, in order for a health care agent to make decisions regarding artificial nutrition and hydration (whether to start or stop) there must be “clear and convincing” evidence that your agent knows your wishes. This means that you must you must either tell your agent or write about your wishes in your Health Care Proxy form.
What is artificial nutrition and hydration?
Artificial nutrition and hydration consists of giving people food and water through either an intravenous (IV) line or through a tube (through the nose into the stomach, or through the skin into the stomach or intestines) as a replacement for ordinary eating. Artificial nutrition and hydration can save lives when used until the body heals from a reversible illness. Long-term artificial nutrition and hydration may be given to people with serious intestinal disorders that impair their ability to digest food, thereby helping them to enjoy a quality of life that is important to them. It is also sometimes used for people with irreversible and end-stage conditions who are unable to feed themselves. Unfortunately in these latter circumstances, giving artificial nutrition or hydration will not reverse the course of the disease itself or improve the quality of life. If I become terminally ill, I do/don't want to receive the following types of treatments... If I am in a coma or have little conscious understanding, with no hope of recovery, then I do/don’t want the following types of treatments:... If I have brain damage or a brain disease that makes me unable to recognize people or speak and there is no hope that my condition will improve, I do/don’t want the following types of treatments:...
Should I list specific instructions or limitations in my health care proxy?
The decision to list specific instructions or limitations regarding artificial nutrition and hydration is a personal one. As Terri Schiavo’s life illustrated, some health care facilities, physicians, family members, and/or friends may not agree with stopping or withdrawing tube feeding, especially when the patient has not made his or her wishes known in this regard. Therefore, it is important to explore this issue with your family members and friends and physician. If you feel strongly about your wishes or you feel it would help your family and friends to follow your wishes to have them written down, you should include them on your health care proxy. However, documenting on your proxy that you have communicated with your agent your wishes regarding artificial nutrition and hydration is also sufficient. Common examples of specific instructions: If I become terminally ill, I do/don't want to receive the following types of treatments... If I am in a coma or have little conscious understanding, with no hope of recovery, then I do/don’t want the following types of treatments:... If I have brain damage or a brain disease that makes me unable to recognize people or speak and there is no hope that my condition will improve, I do/don’t want the following types of treatments:...
Types of Feeding and Hydration
Basic Feeding
Spoon-fed with a regular diet (fluids and solids), if you could tolerate it
Supplemental Oral Feeding
Basic Feeding plus supplements (e.g. high calorie, fat or protein supplements) For example, if you are unable to swallow solids and were able to swallow liquids, you could be given high-energy liquid supplements (like Ensure or Boost) or vitamins
Intravenous (IV) Fluids
Used to temporarily correct dehydration Used to support a patient through a short term acute illness Not a long term solution
Intravenous Feeding (Hyperalimentation)
Give nutrients (water, salt carbohydrate, protein and fat) by intravenous (IV) infusions This method only works for a limited time because the needles required for intravenous feeding eventually damage the veins Used for people whose intestines are not absorbing food, therefore taking food by mouth or through a feeding tube would not be effective Intravenous (IV) lines can be inserted into the large veins near the heart, using minor procedures under local anaesthetic (no major surgery) This method of feeding is called total parenteral nutrition
Tube Feeding
Nasogastric and/or Gastrostomy tubes Nasogastric tubes Soft plastic tubes passed through the nose into the stomach Used for people who can digest food but can’t swallow Most people tolerate them well, but some people find them uncomfortable and tend to pull them out again and again Gastrostomy tubes Tube surgically passed through the skin, directly into the stomach Used for people who can’t swallow or can’t tolerate a nasogastric tube When a person needs feeding for a long time, this method is preferable to a nasogastric tube Can be installed surgically without a general anaesthetic Once in place, they are fairly painless and trouble-free, however a person can pull out their tube, which can be painful and require further surgical intervention
Need more help?? Download the brochure " from"National Hospice and Palliative Care Organization"
References: Excellus BCBS "Advance Care Planning. Compassion and Support at the End of Life." April 2005. Molloy, Dr. D William, Let Me Decide, 2nd edition. Vancouver Island Health Authority. 2004. National Hospice and Palliative Care Organization, "Questions and Answers: Artificial Nutrition and Hydration and End-of-life Decision Making" State of New York Department of Health, "Health Care Proxy: Appointing Your Health Care Agent in New York State"