Nutrition and Hydration at the End of Life
ANA Position Statement
The purpose of this position statement is twofold. The first is to clarify nurses’ roles in the care of patients at the end of life, for whom decisions regarding artificial nutrition and hydration are being considered. The second is to explain how nurses can work with other health care professionals, patients and surrogate decision-makers who are representing the patients’ preferences. Discussions should include the risks, benefits and alternatives to various forms of nutrition and hydration for people who are dying. Dimensions to be discussed include comfort feedings, as well as decisions to forgo food and fluids, dietary supplements, and artificially administered nutrition and hydration.
Statement of ANA Position
Adults with decision-making capacity, and surrogate decision-makers for patients who lack capacity, are in the best position to weigh the risks, benefits and burdens of nutrition and hydration at the end of life, in collaboration with the health care team. The acceptance or refusal of clinically appropriate food and fluids, whether delivered by oral or artificial means, must be respected, provided the decision is based on accurate information and represents patient preferences. If a patient chooses food, even if that intake may cause harm (e.g., oral feedings in people who are at risk of aspirating), the nurse is responsible for minimizing risk (i.e., using both positional changes and slow, assisted feedings). This is consistent with ANA’s values and goals of respect for autonomy, relief of suffering and expert care at the end of life (ANA, 2015; ANA, 2016).
The decision to voluntarily stop eating and drinking, referred to here as VSED, with the intention of hastening death can be made only by those patients with decision-making capacity, not by surrogates. A patient’s decision regarding VSED remains binding, even if the patient subsequently loses capacity.