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Tube Feeding (Fluids and Food) |
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 Choosing
to stop eating and drinking
Occasionally patients do make a deliberate choice to stop taking in
food and fluids and they may actually say they are doing this to speed
up the dying process. These are people in the last stages of a terminal
disease. They do not suffer from a mental illness or other condition
that has affected their reasoning. They are not suicidal in the usual
sense of the word. They have concluded that the burden of living has
gotten so great that they would rather die sooner.
This choice is usually disturbing to family members and the medical
personnel. When a patient does make such a choice the family and caregivers
do need to be sure that the patient is not suffering from depression
or inadequate pain control. Perhaps these conditions could be adequately
managed and once under control the patient may no longer want to hasten
death. It is very important to consider the conditions that the patient
feels are too great a burden and see if they can be relieved. These
burdens may be emotional issues such as discord in the family or spiritual
issues.
After the emotional, spiritual and symptom management issues have
been adequately addressed, the patient may still choose to refuse
to eat. If this happens, it usually is in the very last days of the
course of the disease. Just as a patient can refuse surgery or chemotherapy
that might prolong life, a patient also can refuse to eat. However,
finally, the patient’s decision binds everyone else.
A Case Study
The patient was 42 years old and had been suffering from slowly disabling
neurological disease for ten years. He had concluded the burden of
living had become so great that he was ready to die. He had a faithful
and loving wife, a caring larger family and even continued to work
as a consultant out of his home. He was confined to his wheelchair
or to bed. He was totally dependent on others for all his care. He
took massive doses of medications just to be able to get out of bed
in the morning and keep his vital systems going. He experienced regular
infections and occasional hospitalizations. He was a man of deep faith
and regularly worshipped at his congregation. He knew his disease
was terminal and that his condition would only get worse.
He rejected the idea of suicide for moral reasons as well as the burden
it would place on his family. He chose to stop all his medications
and let the disease run its natural course as quickly as possible.
Over the months following this treatment plan, he became weaker and
more frail. He kept a low grade bladder infection, enough to make
him uncomfortable. His heart and other vital systems were failing.
Six days before his death he stopped eating and drank only sips of
water. He was fully conscious during his last days. He had pushed
his body to his physical limits and knew that to refuse to eat and
drink would allow his death to come more quickly. He died peacefully
in the night, his wife sleeping at his side. |
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Adapted from The
Handbook for Mortals: Guidance for People Facing Serious Illness,
by Joanne Lynn and Joan Harrold, copyright by Joanne Lynn, used by
permission of Oxford University Press.
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