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Medical Edge Newspaper Column from Mayo Clinic
WHAT YOU NEED TO KNOW BEFORE YOU WRITE A LIVING WILL
DEAR MAYO CLINIC: How long can a person go without food and
water? If you are dying, can a hospital withhold food and water from you
if that is what the family wants? What are the results of not having water
or food for two weeks? I’m writing my living will and would like to have
answers. — Chicago
ANSWER: I’m glad you’re seeking answers as you write a living will.
Your wishes, when they are known, will guide end-of-life care.
People can generally go without food and water for about two to three
weeks. This will vary based on underlying health or illness. For people
who are very ill, with little body fat, survival may be much shorter.
But a more important question is, what do you want the food and water
to do? Make you more comfortable? Avoid hunger? Extend your life? At the
end of life, artificial nutrition — through a feeding tube or intravenous
fluids — might not meet those goals.
In many cases, at the end of life, artificial nutrition doesn’t make a
patient feel better. In fact, there’s a risk of complications that can
make the patient feel worse. And in most cases, it doesn’t extend life.
That’s because something happens in advanced cancer and other advanced
diseases (including heart disease, lung disease, tuberculosis, etc.) that
makes food in any form ineffective. We don’t understand what exactly causes
this.
Studies have shown that patients with advanced cancer who use feeding
tubes do not gain any new muscle mass or lean body tissue. They may gain
a small amount of weight, but this is mostly retained fluid. That fluid
can cause problems, such as increased difficulty breathing because the
fluid can go into the lungs. Fluids can also cause sometimes painful swelling
in arms and ankles.
Artificial feeding may shorten survival time due to complications from
the feedings. They can include aspiration pneumonia (where the food goes
into the lungs), infections, blood clots, bleeding and a perforated stomach.
What about hunger? Most people dying of some advanced disease such as
cancer or heart disease lose their appetite and aren’t bothered by hunger.
Studies show that eating small amounts of favorite foods can alleviate
whatever hunger is present. Often the family is more bothered by lack
of eating than the patient. But studies show that it’s unlikely that eating
or nutrition via a tube will change the course of the illness near the
end of life.
What about thirst? Studies done in this same population of patients show
that intravenous fluids do not relieve thirst. Other studies done in the
hospice setting show that most thirst is relieved by sucking on ice chips,
taking sips of water and maintaining lip moisture with lip balms.
For patients with advanced cancer, it’s unclear if providing IV fluids
makes people live longer. The general sense of most people who practice
hospice and palliative care medicine is that fluids don’t extend life.
For other disease states, it is less clear.
A hospital can withhold food and water when you are dying if this is in
accordance with your wishes. The consensus of legal, medical and most
religious opinion, including the U.S. Catholic Bishops, is that artificial
hydration and nutrition represent extraordinary care. At the request of
the patient, or patient’s spokesperson, extraordinary care can be stopped.
The best thing you can do is talk about this issue openly and well ahead
of time with family, health-care providers, clergy or others. Families
often feel the need to provide nutrition to nurture and soothe a loved
one. When you and your family understand what artificial nutrition can
and cannot do, you can make the decision that meets your goals. And by
all means document your wishes in writing in your living will.
— Timothy Moynihan, M.D., Medical Oncology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Living
Will
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2005 TRIBUNE MEDIA SERVICES, INC.
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