From the Guidelines
Hospice care does not intentionally starve patients, and decisions to withhold nutrition are made with the patient's best interests in mind, prioritizing their comfort, dignity, and quality of life. The goal of hospice care is to allow natural processes to occur while managing symptoms and providing comfort, rather than forcing nutrition that may cause discomfort. As people near death, their bodies naturally reduce food and fluid intake as part of the dying process, and forcing nutrition can sometimes cause bloating, nausea, or respiratory distress 1.
According to the most recent guideline on clinical nutrition and hydration in geriatrics, older persons with low nutritional intake in the terminal phase of illness should be offered comfort feeding instead of artificial nutrition, with a grade of recommendation based on consensus and expert opinion 1. This approach prioritizes the patient's quality of life and allows them to consume food and drink orally, in the amount they like, without focusing on covering their nutritional requirements.
In line with this, the ESPEN guideline on ethical aspects of artificial nutrition and hydration states that artificial nutrition and hydration should not be used solely to reduce the workload of nursing staff, and that decisions to withhold or withdraw these interventions should be based on the patient's best interests, taking into account their advance directives and quality of life 1. The decision to withhold artificial nutrition can be taken while hydration is continued, and comfort care should still be provided, even when artificial nutrition and hydration are discontinued.
It is essential to note that hospice teams work closely with families to explain the natural changes that occur as a person nears death and to ensure that patients receive appropriate mouth care to prevent discomfort from dryness. Any concerns about a patient's care should be discussed directly with the hospice team, and family members can receive emotional support and education about this normal aspect of dying. Ultimately, the goal of hospice care is to prioritize the patient's comfort, dignity, and quality of life, rather than forcing nutrition that may cause discomfort.
From the Research
Hospice Care and Nutrition
- The provided studies do not directly address the issue of hospice care withholding nutrition from patients 2, 3, 4, 5.
- However, it is mentioned that hospice care focuses on providing comfort and promoting quality of life for individuals and their families, which may include managing symptoms and providing emotional and spiritual support 4, 5.
- Some common myths surrounding hospice care are explored in one study, including the idea that hospice "starves" patients or withholds food and water 6.
- This study aims to dispel these myths and provide a clearer understanding of hospice care, but it does not provide specific information on the practice of withholding nutrition from patients 6.
Patient Autonomy and Care
- Hospice care is centered around the patient's needs and wishes, with the goal of preserving the patient's dignity and autonomy 2, 4.
- The patient or family makes the final decisions regarding care, and the hospice team provides support and guidance throughout the process 2.
- The focus of hospice care is on providing comprehensive comfort care, including medical care, pain management, and emotional and spiritual support, rather than on withholding specific treatments or interventions 3, 5.
Goals of Hospice Care
- The primary goal of hospice care is to provide a peaceful and comfortable death, while also supporting the patient's family and loved ones 4.
- Hospice care is appropriate when the patient's prognosis is 6 months or less, and the focus is on maximizing the patient's quality of life and minimizing symptoms and discomfort 3, 5.