Witnessing a loved one weaken due to a serious illness is undeniably painful. This experience becomes even more emotionally charged when family members and caregivers observe a hospice patient declining food and drink as they approach the end of life. It’s natural to have concerns and questions during this sensitive time.
Families often grapple with questions like:
- Are we abandoning our loved one if we don’t try to feed them or offer fluids?
- What is the likelihood of survival without food and water in hospice care? Specifically, How Long Can Someone Live Without Food when receiving hospice care?
- Our family traditions are deeply intertwined with food and drink as expressions of love and care. Are we depriving them of love by not providing nutrition and hydration? Are we causing them to starve?
- Will withholding food and water at the end of life inflict pain on our loved one?
- What actions can we take to ensure our loved one’s comfort and prevent suffering?
Why Hospice Care Often Involves Reduced Food and Water Intake
Continuing to push food and water, or resorting to 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 paradoxically complicate the dying process and introduce new health issues.
For end-of-life patients, artificial feeding methods can lead to distressing complications like gagging, tube-related problems (blockages or infections), discomfort, aspiration pneumonia, pressure sores, bloating, and a suffocating sensation of “drowning” or feeling “trapped.”
Moreover, research consistently shows that artificial nutrition offers minimal, if any, extension of life for hospice patients. For instance, studies indicate that dementia patients receiving tube feeding do not exhibit a different life expectancy compared to those who are carefully hand-fed.
Feeding Tubes: Understanding the Challenges
Hospice care will still be provided to a patient who already has a feeding tube. The hospice team will collaborate closely with the patient, family, and caregiver to determine whether continuing tube feeding is appropriate. While technically a feeding tube can be removed, the common decision is to discontinue its use.
Typically, 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 intake remains the primary mode of feeding and drinking when possible.
Determining When to Stop Feeding a Hospice Patient
A dying patient’s nutritional and hydration requirements are fundamentally different from those of a healthy, active individual. As life nears its end, the body gradually loses its capacity to effectively digest and process foods and liquids. As organ systems and bodily functions slow down, the need for nutrition and hydration diminishes significantly, sometimes becoming negligible. Observing the body’s natural decline serves as a key indicator for when to reduce or stop providing food and water to hospice patients.
Hospice organizations prioritize creating personalized care plans in partnership with patients and families. These plans are designed to align with the patient’s wishes and values, and they always include a comprehensive discussion about the role, or lack thereof, of artificial nutrition and hydration.
Understanding Survival Time Without Food in Hospice
Given the many individual factors at play, it’s understandable to wonder how long can someone live without food within a hospice setting. Following the cessation of eating, a patient’s life expectancy can range from just a few days. For the majority of individuals, this period without food typically lasts around 10 days, but in some instances, it can extend to several weeks.
Supportive Actions for Families and Caregivers
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 receive desired comfort care.
Family members and caregivers provide crucial support throughout the dying process:
- If the patient is still able to eat or drink, offer small sips of water or other liquids, ice chips, hard candies, or tiny spoonfuls of soft food. Pay close attention to the patient’s cues to know when to stop.
- If the patient can no longer drink, keep the lips and mouth moist using swabs, a damp cloth, lip balm, or moisturizers.
- If the patient can no longer eat or refuses food, offer alternative forms of nourishment: engage in conversation, provide loving touch, play music, sing, read poetry, share humor, arrange pet visits, offer gentle massage, read aloud, pray together, or engage in other acts of care and affection.
Creating a Compassionate End-of-Life Care Approach
Ideally, end-of-life care decisions are made while everyone is healthy and can express their wishes clearly. This is the optimal time to create and share an advance directive with family and healthcare professionals.
However, in reality, these important decisions are often postponed until the patient is no longer able to communicate their preferences. This situation leaves family members and the healthcare team to make informed choices. Hospice professionals are equipped to provide specialized care and support regarding nutrition and hydration as death approaches:
- The hospice team will continue to focus on pain management and symptom relief.
- The patient’s personal, cultural, and religious beliefs and values concerning nutrition and hydration will be respected.
- Family members and caregivers will receive guidance on how to compassionately manage thirst and hunger without resorting to artificial means in the patient’s final days.
- In the final weeks, days, and hours of life, families will be reassured that the patient’s decline and eventual death are a result of the underlying disease progression, and not due to the natural decrease and eventual cessation of eating and drinking.
