The Myth of Artificial Nutrition in End of Life Care


As a cancer survivor and a registered dietitian, it is difficult for me to see my oncology patients not able to tolerate food.

One of my patients with incurable cancer was admitted with bowel obstruction and therefore unable to tolerate any liquid, not to say solid food. After numerous unsuccessful trials of liquid, this patient decided to get a venting gastrostomy for palliative care and go home with hospice service.

However, because of guilt of seeing their loved one suffer from starvation, one of the family members brought up the idea of parenteral nutrition to go home with, which contradicts with the medical team's recommendation.

Parenteral nutrition is a form of artificial nutrition and hydration in which nutrition and fluid are delivered via an intravenous catheter to provide partial or total nutrition support.

However, artificial nutrition and hydration require the patient to undergo uncomfortable procedures for the nutrition support to be started. It has known side effects and potential complications, such as increased risk of infection, fluid overload, nausea/vomiting and diarrhea, electrolyte disturbances, and even early death in serious cases.

In fact, patients who receive no artificial nutrition and hydration do not experience more negative side effects than those who do. Dying patients rarely feel hungry or thirsty. Fewer calories are needed at the end of life. There is a myth that dehydration and hunger in terminally ill patient are uncomfortable, but in fact dehydration leads to increased dynorphin and lack of dietary intake produces more endorphins which are analgesic and may increase comfort. Fewer calories are needed at the end of life. Patient should not be made to feel guilty if they do not wish to eat.

The bottom line is 'less is more' is okay in a sensitive situation like this.


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