Artificial Nutrition and Hydration

Artificial nutrition and hydration, also called ANH or tube feeding, may be offered to someone who is unable to swallow food and liquids without choking. In most instances, liquid nutrition is delivered through a tube that has been surgically inserted into the stomach or intestines, bypassing the normal digestive process that begins in the mouth. ANH can be helpful to a patient whose condition can improve or be reversed, or whose ability to swallow can be safely restored such as when surgery affects the digestive system, or if there is a blockage that prevents normal digestion.

Studies show that ANH does not extend life in patients who are near death or whose disease is so advanced they are unlikely to improve. In Alzheimer’s disease and dementia patients in particular, studies show that tube feeding can actually cause harm. Complications from tube feeding can include pain, bloating and aspiration pneumonia, and may decrease quality of life as well as life span. Additionally, dementia patients may need to be physically restrained or sedated by medicine to keep them from dislodging the feeding tube. As a result of becoming immobile, they are at much greater risk of developing painful pressure ulcers.

The patient or his/her legally-authorized surrogate decision-maker has the right to decide whether to withhold or withdraw ANH based on medical information concerning the patient. Medical ethicists draw no distinction between withholding and withdrawing ANH.

The issue of nutrition and feeding is complicated and can be fraught with significant emotional burdens. Providing food and the act of feeding symbolize love and nurturing and are associated with improving health and sustaining life. Thus, it is difficult sometimes for family members to understand how tube feeding could be harmful.

Although families often are concerned that hospices will not accept a patient with a feeding tube, this is rarely the case. Hospices generally agree to enroll such patients but will likely try to educate them and/or family or surrogate about the benefits and burdens of ANH. If or when a decision is made to discontinue ANH, the feeding tube usually can just be capped and allowed to remain in place. 

In 2012, Hospice Foundation of America brought together a panel of clinical experts to educate other clinicians about the dilemmas that sometimes arise around tube feeding and to correct misinformation about artificial nutrition and hydration. You can watch a video clip of part of their discussion on this page.