Nutrition and hydration are vital to life. Some conditions prevent a person from being able to take adequate nutrition by mouth. In these cases, a feeding tube can be inserted to provide 100 percent of nutritional needs. In some instances, such as a terminal disease, the patient will refuse to have a tube placed for feeding. Ultimately, death will result from starvation and dehydration when nutrition and fluids are refused 2.
In certain cases, a person is physically able to eat and drink but not able or willing to ingest enough nutrition to maintain a healthy weight and proper body functions. A feeding tube can be used to supplement the difference and meet nutrient and fluid needs. If the feeding tube is refused, weight loss and reduced muscle mass will cause inadequate organ function and an inability to fight infectious diseases, ultimately leading to death.
Sub-Optimal Route of Nutrition
Dobbhoff Feeding Tube Vs. PEG
A substitute method of feeding is performed by infusing nutrients through a large vein. This requires surgical placement of a catheter and employs significant risks and complications. When a feeding tube is refused in lieu of intravenous nutrition, the gut does not receive nutrients directly. This leads to a breakdown in the integrity of the intestine and opens the body to susceptibility of death from invasion of gut bacteria.
- A substitute method of feeding is performed by infusing nutrients through a large vein.
- When a feeding tube is refused in lieu of intravenous nutrition, the gut does not receive nutrients directly.
When nutrition by tube feeding is refused, the body is deprived of a dietary source of calories and protein and must turn to the cells within. The textbook “Anatomy and Physiology” explains that fat stores are where the body turns first for energy. Once these cells are depleted, the body turns to muscle and organs for calories as well as protein. As the mass of the organs shrinks, degeneration of organ and cell function result. Organ failure is ultimately what leads to death from starvation.
- When nutrition by tube feeding is refused, the body is deprived of a dietary source of calories and protein and must turn to the cells within.
- Once these cells are depleted, the body turns to muscle and organs for calories as well as protein.
What Is Protein Poisoning?
Refusing a feeding tube also means the patient will not receive hydration. Dehydration leads to a relatively quick demise. James Park, in his manuscript “Voluntary Death by Dehydration,” reports that within a week the mind becomes unconscious followed by the heart and lungs ceasing to work 2. Most people will not live more than seven days when fluid is denied. Discomforts such as thirst, a dry mouth and cracking lips may be expected. Wiping the mouth with a wet swab will alleviate these side effects.
- Refusing a feeding tube also means the patient will not receive hydration.
- Wiping the mouth with a wet swab will alleviate these side effects.
The Dying Process
Family Guide, a program to help families decide on tube feeding options, explains what to expect when a person refuses nutrition: weakness, weight loss, reduced ability to recover from an illness and reduced awareness of surroundings will occur. James Park notes that the choice of this terminal situation allows the patient to be with loved ones who are prepared for what to expect.
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- Ottowa Hospital Research Institute
- Voluntary Death by Dehydration
- Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol. 2014;20(26):8505-24. doi:10.3748/wjg.v20.i26.8505
- Ojo O, Keaveney E, Wang XH, Feng P. The effect of enteral tube feeding on patients' health-related quality of life: A systematic review. Nutrients. 2019;11(5). doi:10.3390/nu11051046
- Metheny NA, Hinyard LJ, Mohammed KA. Incidence of sinusitis associated with endotracheal and nasogastric tubes: NIS database. Am J Crit Care. 2018;27(1):24-31. doi:10.4037/ajcc2018978
- Rahnemai-azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol. 2014;20(24):7739-51. doi:10.3748/wjg.v20.i24.7739
- Yoon EWT, Yoneda K, Nakamura S, Nishihara K. Percutaneous endoscopic transgastric jejunostomy (PEG-J): a retrospective analysis on its utility in maintaining enteral nutrition after unsuccessful gastric feeding. BMJ Open Gastroenterol. 2016;3(1):e000098corr1. doi:10.1136/bmjgast-2016-000098
- Geppert CM, Andrews MR, Druyan ME. Ethical issues in artificial nutrition and hydration: a review. JPEN J Parenter Enteral Nutr. 2010;34(1):79-88. doi: 10.1177/0148607109347209
- Complex Feeding Decisions: Perceptions of Staff, Patients, and Their Families in the Inpatient Hospital Setting, Miles A, Watt T, Wong WY, McHutchison L Friary P, Gerontol Geriatr Med. 2016 Aug 22.
Laurie Beebe is a registered dietitian with more than 25 years of experience in hospital and university settings. She is certified in adult weight management and trained in personal coaching. She is a graduate of the University of Florida and earned her master's degree from Case Western Reserve University.