Making decisions around artificial feeding

In the advanced stages of dementia, some people lose the ability to swallow safely or even to swallow at all.

This usually occurs within days or weeks of the end of their life. In these circumstances, and if the person cannot make the decision for themselves, someone else might have to decide how best to feed them. They may have to decide to give food or fluid through a tube. This is known as artificial feeding or hydration.

The person may have already anticipated this type of treatment and decided to refuse it through an advance decision (see ‘Planning ahead’). If not, and if someone has a personal welfare LPA, then the attorney can speak with the doctor or medical professional to make a decision. 

If there is a disagreement about what is best, the Court of Protection can be asked to decide. While the Court can make decisions quite quickly, in the meantime the person will continue to be offered life-sustaining treatment. If there is no personal welfare LPA in place, families and carers should still be consulted by medical staff when making these decisions. However, generally it is the medical professionals that will make the final decision.

For many carers, the issue of artificial feeding or hydration is not wholly clear, and discussing the stopping of food or fluids is very difficult. Some may feel that to do so is morally wrong. This decision is complex because there is no clear evidence that someone nearing the end of life will always benefit from artificial feeding or hydration, either to relieve symptoms or prolong life. Loss of the ability to swallow can be a natural part of the dying process. At this stage the focus of care should move away from trying to prolong life, and towards achieving good quality of life – and good quality of death.

It is important to think about the person’s best interests, including any relevant religious or moral beliefs that they hold. It is also important to remember that any aspect of treatment, including stopping food and drinks, should not mean the person will be left in pain or discomfort.

Things for carers to think about around artificial feeding:

  • What alternatives to artificial feeding or hydration are there, if any?
  • Are there any indications that this might be just a temporary phase?
  • Would artificial feeding or hydration affect the person’s dignity or be against their beliefs?
  • Would they have chosen to be fed or hydrated artificially if they could have foreseen the situation?
  • Would the person’s quality of life be improved if they were artificially fed?
  • Would artificial food or fluids cause them distress or make them uncomfortable?
  • What do others think? Have you discussed the matter honestly and openly with friends, relatives and professionals?
  • What emotional support have you been offered at this very difficult time?
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