Choose to have artificial hydration and nutrition when you are
no longer able to take food or fluids by mouth.
Choose not to have artificial hydration and nutrition.
Key points to remember
Your decision about having
artificial hydration and nutrition will depend on:
The benefits and risks of using (or not using) these treatments. Talk with your doctor about your illness, your
treatment choices, and whether artificial hydration, artificial nutrition, or
both will improve your quality of life.
Your medical condition. The short-term
use of artificial hydration and nutrition can be helpful to people with
short-term (acute) illnesses. But for some people facing a terminal illness,
these treatments may prolong life but not improve it. These treatments will not
cure your illness.
Your comfort. People react in different
ways to artificial hydration and nutrition. Some people feel better with this
treatment as they near the end of life. But it can cause problems for others,
such as swelling in the arms and legs, fluid in the lungs, nausea, or stomach bloating.
Whether you decide for or against artificial hydration or nutrition, your
doctor will take measures to help you feel comfortable.
Your personal feelings about artificial hydration and nutrition. If you believe that artificial hydration,
artificial nutrition, or both will make your life longer but not better, you
may choose not to receive them. On the other hand, you may feel that these
treatments will improve the quality of the time you have left. Or you may
believe that food and water are basic human needs and should be provided, no
What is artificial hydration and nutrition?
may come during the course of your illness when you may eat and drink less. The
changes in your appetite and fluid intake may be linked to your general
weakness and slowing
metabolism. Some illnesses can make it hard for you to
swallow or can cause nausea and vomiting. It is important to talk with your
doctor about what to expect as your illness gets worse.
aren't able to take food or fluids by mouth, an
intravenous (IV) line or feeding tube can be used to
provide fluids and nutrition. An IV is a needle that is put in
your vein through which fluids, liquid nutrition, and medicines can be given. A
feeding tube can be either a tube placed in the stomach through the nose or
surgically inserted through the belly into the stomach. The tube supplies
medicines, fluids, and nutrition. You can also get artificial hydration from
fluid injections into tissues under the skin.
For people with acute
illness or injury, short-term use of IVs, injecting fluids under the skin, and
feeding tubes can be helpful. And in some cases, long-term hydration may work
well. For example, long-term hydration may help your kidneys do their job or
may help you avoid some of the side effects of medicine. But for people facing
a terminal illness, there may come a time when the risks of artificial
nutrition and hydration outweigh the benefits.
What are the benefits of artificial hydration and nutrition?
Some people facing a terminal illness may benefit from
getting IV fluids, fluids injected under the skin, or a feeding tube. For
instance, these treatments may work well for illnesses that make it hard to
swallow or cause nausea and vomiting.
When used the right way,
artificial hydration or nutrition may increase your energy and comfort. But the
benefits may not last. It is important to talk about your treatment goals with
your doctor. What do you want to happen if you receive artificial hydration and
nutrition? If these goals are not met, what would you want to do next?
Talk with your doctor about your illness. Ask if artificial hydration and
nutrition will make your quality of life better.
What are the risks of artificial hydration and nutrition?
All types of artificial hydration and nutrition have
IV lines and feeding tubes
You can get an infection at the site where the IV is
To lower your risk of infection, the IV site may be changed
every few days. Having an IV inserted can be painful.
IV fluids can cause swelling in your arms and legs, or you
may get fluid in your lungs that can make it hard to breathe.
Your body may not be able to handle the extra fluids. Other
parts of your body may swell, or you may get fluid in your lungs, which makes
You may get
pneumonia if you inhale fluid from your mouth (saliva) or your stomach into
A tube placed in your stomach through the belly can get
infected at the insertion site.
The feeding tube may irritate your stomach lining, which
sometimes can lead to stomach ulcers.
A feeding tube may cause nausea, bloating, heartburn, or an upset
Another problem that can be linked to IVs and
feeding tubes is the limits they pose on activity. Being connected to tubes or
an IV may limit your ability to walk or move around in a
What are the risks of not receiving artificial hydration and nutrition?
If you choose not to have these treatments, you may be
missing therapies that could improve the quality of the time you have left.
Artificial hydration or nutrition may increase your energy and relieve symptoms
of nausea and weakness.
If you are unable to speak and have not
shared your wishes about artificial hydration and nutrition, your doctor or
family may face some tough decisions. If you are unable to eat or drink, you
may receive care that you don't want. For this reason, it's important to
discuss your wishes about artificial hydration with your doctor and family.
State your wishes clearly, and put them in writing in an
Why might your doctor recommend artificial hydration and nutrition?
Your doctor may suggest that you receive these
Short-term use of artificial hydration and
nutrition can help you recover from an acute illness or injury.
feel that artificial hydration and nutrition will improve the quality of your
There is hope that there is or will soon be a cure for your
When you are diagnosed with a serious illness, you and
your doctor will talk about treatment choices and how likely it is that your
illness will be cured. If your illness can't be cured and if it is likely to
shorten your life, your doctor may talk to you about receiving care that will
keep you comfortable without making your life longer.
may also talk to you about your desire to receive IV fluids or tube feedings
when you are no longer able to take fluids or food by mouth. Ask your doctor to
be as specific as possible when discussing your treatment options. You may want
to get a second opinion about your diagnosis and treatment options.
Deciding whether to have artificial hydration or nutrition is hard. If
you choose these treatments, talk with your doctor. Make a plan to stop the
treatments when it becomes clear to you, your family, and your doctor that
treatment is not helping you. For instance, you may choose to receive an IV for
a certain number of days. If you do not receive any benefit or if you have
problems, the treatment will be stopped.
Do your personal feelings about artificial hydration and nutrition matter when making this decision?
YesYou're right. You may feel that these treatments should be provided no matter what. Or you may feel that they won't add to your quality of life. Either way, your beliefs matter.
NoSorry, that's not right. You may feel that these treatments should be provided no matter what. Or you may feel that they won't add to your quality of life. Either way, your beliefs matter.
I'm not sureIt may help to go back and read "Get the Facts." You may feel that these treatments should be provided no matter what. Or you may feel that they won't add to your quality of life. Either way, your beliefs matter.
Will these treatments cure your illness?
YesSorry, that's not right. These treatments may prolong life, but they will not cure your illness.
NoYou're right. These treatments may prolong life, but they will not cure your illness.
I'm not sureIt may help to go back and read "Compare Your Options." These treatments may prolong life, but they will not cure your illness.
Will these treatments cause any side effects?
YesYou're right. These treatments can cause problems for some people, such as swelling in the arms and legs, fluid in the lungs, nausea, and bloating.
NoSorry, that's not right. These treatments can cause problems for some people, such as swelling in the arms and legs, fluid in the lungs, nausea, and bloating.
I'm not sureIt may help to go back and read "Get the Facts." These treatments can cause swelling in the arms and legs, fluid in the lungs, nausea, and bloating.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Not sure at all
Check what you need to do before you make this decision.
I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.
Use the following space to list questions, concerns, and next steps.
Personal stories about artificial hydration and nutrition
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
My family is
very concerned that I don't drink enough water or eat as much as I once did. We
spoke to my doctor about these concerns, and she informed us that it is normal
for a person to eat and drink less as their illness progresses. In fact, she
told us that receiving IV fluids may be risky for me because I have heart
failure. I am comfortable and do not feel hungry or thirsty. I feel IVs or an
artificial feeding tube would cause more problems.
Ada, age 77
I have been
diagnosed with ovarian cancer. The cancer causes fluid to build up in my belly,
causing me to have a lot of nausea and vomiting. Because I cannot keep fluids
down, IV fluids help me stay hydrated. I also receive nutritional supplements
and my pain medication through an injection into my IV line. The IV is
definitely making me more comfortable.
Isabel, age 42
workers and doctor talked to me about what to expect as my death gets closer. I
had heard that not being fed is painful. I was very concerned about starving to
death or becoming too thirsty. They informed me that my body will not need as
much food or water as time goes on and that there are ways to keep me
comfortable without tubes or IVs, like swabbing my mouth to keep it moist. They
also told me that going without food is not painful since I won't be hungry as
I get weaker. I prefer to be kept comfortable without IVs or an artificial
I was diagnosed with chronic leukemia
several years ago. I notice that if I do not get enough fluids into my system,
I become weaker. I go in to my doctor's office every few weeks to receive IV
fluids. After the IV, I feel like I have more energy. My doctor has told me
that a time will come when I will not feel as energetic after the IVs. He has
also told me that a time may come when I develop problems from the IVs, like
swelling in my feet or fluid in my lungs. My doctor, family, and I have decided
to continue the IVs for as long as I see improvement. When the time comes that
there is no benefit, we will stop the treatment.
Al, age 74
Last Revised: July 6, 2012
Anne C. Poinier, MD - Internal Medicine Shelly R. Garone, MD, FACP - Palliative Medicine