Artificial Nutrition and Hydration (ANH): Is it Really What you Want?

Dr.Michael Gordon Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

The use of artificial nutrition and hydration (ANH) has become relatively commonplace. With the development of the PEG years ago, the difficulties that surrounded the use of naso-gastric feeding tubes have all but disappeared. However, the clinical, ethical and legal aspects of ANH have replaced issues of procedural techniques and the discomfort experienced by older patients when the nasogastric tubes were used for prolonged periods. Many in the field of aging and long-term care in particular are particularly sensitive to the long-term implications for the patient and family once ANH is implemented. The issues of starting such intervention when its discontinuation may cause moral conflict, legal challenges and for many who are believers religious conundrums must be considered especially when such decisions are being made during a period of crises and clinical uncertainty.
Key Words: artificial nutrition, hydration, long-term care, implications.


I believe that issues surrounding AHN should be a focus for next steps in the Choosing Wisely Canada campaign. I know that the geriatrics society touched on the concept, but I don't think their statement is strong enough to enable patients/families/physicians/POA to make better decisions regarding the use of AHN. Do you see the campaign as a possible route for improving patient care in this sensitive area?

Thanks for your comment and suggestion. I think any and every activity or "campaign" in which such issue are important to consider should be used as a vehicle to bring the discussion to the attention of those who may be on the receiving end and those responsible for making decisions often as a substitute decision maker-- it is often hard to think about until it faces you directly as a real decision for someone you love: therefore better to have thought about and discussed when there is no crises occurring. A crises is the worst time to have to make such a decisions and many loved ones make it with the hope that things will improve only to find that over the the decision they have made appears to have not acheived their hopeful goal--then it is often emotionally difficult to reverse.

Michael: I am happy you found it useful. Michael

Hi Dr. Gordon - Thanks for this very thoughtful and interesting article. MP