Artificial nutrition and hydration (ANH) – A medical intervention intended to provide temporary nutritional support; primarily used when patients cannot take in nutrients on their own but are expected to recover.
Durable power of attorney (DPOA) – A power of attorney that typically remains in effect until the death of the principal or until the document is revoked; remains valid even in the event the principal is unable to make personal decisions due to incapacity.
Question: On a living will document, what’s the average or typical number of days listed for artificial nutrition and hydration?
Answer: This is an important question, and it relates to an issue that’s sensitive in nature and often emotionally charged. Before we can talk about “the average or typical number of days,” it’s important to discuss the relevance of artificial nutrition and hydration for specific patients—when it’s useful and when it’s not.
What is artificial hydration and nutrition?
ANH is a medical intervention intended to provide temporary nutritional support. It’s primarily used when patients cannot take in nutrients on their own but are expected to recover to their previous state of health and will once again be able to eat and drink on their own.
For example, we use it for this purpose after serious accidents and sometimes for patients who are actively being treated for head and neck cancer. There are some conditions in which the capacity to swallow is permanently compromised but the rest of the body is functioning fine. In this circumstance, the provision of ANH will allow the life of the patient to be meaningfully sustained.
Use of artificial nutrition and hydration when the patient is terminal
However, it’s important to be mindful of the state of the patient’s health and capacity to heal before starting ANH. In most cases where patients are in the midst of a terminal illness, ANH is not typically recommended. In those circumstances, the body often no longer has the capacity to heal. The body will typically lack the ability to use the nutrients, and ANH (and even simple IV fluids) won’t provide any improvement.
In fact, studies have consistently demonstrated that patients in a terminal state who receive ANH have an increased symptom burden (increased pain, nausea, abdominal cramping and diarrhea), and it may actually shorten their life expectancy. In those cases, it’s important to acknowledge the reality that an illness is terminal and focus on opportunities to make patients comfortable in their final days.
Examples of illnesses where we see adverse consequences to ANH include end-stage Alzheimer’s disease and some advanced cancers that are beyond the point of cure or remission.
How to decide if artificial nutrition and hydration should be implemented
So, the question is not “how many days,” but whether ANH will provide meaningful benefit or inflict harm. If a patient has the ability to ultimately recover and do well and ANH can assist in that effort, then it should be started and continued for as many days as it takes until the patient has experienced sufficient recovery and is now able to eat and drink independently. If a patient has a terminal illness and ANH will not help to provide comfort or meaningful recovery, then no number of days should be considered.
Including artificial nutrition and hydration language in an advance directive
In completing an advance directive (or living will if that is your state’s designation), rather than checking a box or listing a number, I recommend a statement such as, “I do not wish for artificial nutrition and hydration to be initiated in any circumstances in which my condition is terminal and ANH is not expected to improve my level of comfort or quality of life.”
More important, however, is making sure you have designated a durable power of attorney who will make decisions on your behalf when you’re no longer able to do so. The DPOA should know your values and preferences and, in consultation with your doctors, will direct the medical team to create a plan of care consistent with your wishes.