ANH for Dying Patients: Benefits and Risks

Artificial nutrition and hydration at the end-of-life care is one of the more prominent/often seen ethical issues and it is critical for nurses to explore the potential benefits/harms. The article talks about patients who have incurable chronic diseases and poor prognosis. Some professionals believe that dehydration makes the patient uncomfortable, which can result in electrolyte imbalance but others believe that it is not painful. Some even believe that artificial hydration can be more distressful when a patient is dying.

Some studies have shown that electrolytes in a dying patient are usually in the normal range. One theory supports that decreased nutritional intake increases the level of endorphins, making the patient rather comfortable and another theory says a ketoacidosis. So, it is difficult to make decisions about withholding or continuing food and fluids when a patient is dying.

This article provides five ethical principles which are taken into consideration when trying to provide ANH to the dying patient. These include beneficence, justice, virtue, autonomy and nonmaleficence.

Several virtues such as fidelity, compassion and honesty are also very critical to the ethical delivery of health care. In this article, some of the professional organizations have given some guidelines to resolve this ethical issue and I fully agree with the resolution. These guidelines apply to patients with terminal illnesses. In 1992, The American Dietetic Association (ADA, 1987) issued a paper stating that a competent patient has the right to refuse medical treatment, including ANH.

However, they do not distinguish between nutritional support or any other medical treatment, which may be withheld or withdrawn by the patient at any time.

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In 1992, The American Nurses Association (ANA) issued a paper on ANH stating that reduced appetite is a normal part of the dying process. Nurses do not have to feel obligated to engage in extraordinary measures of feeding the patient against his will and could be inappropriate. (ANA, 1992). Though the full assessment of the patient’s condition is reported to the MD by the nurse, such as fluid weeping through skin, it is the doctor’s responsibility to determine if death is eminent when artificial feeding is causing discomfort and needs to be discontinued. The challenge for nurses is to explain various treatments and procedures, and encourage patients to discuss their condition and options with their physicians before completing an advance directive.