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Artificial nutrition and hydration at the end of life

  • Topic

Tube or intravenous feeding is a medical treatment: it needs an indication, a goal and consent, and it can be withheld or withdrawn.

Updated

What it is

Artificial nutrition and hydration are given by tube (enteral) or by vein (parenteral). The ESPEN ethics guideline (2016) treats them as a medical intervention that requires an indication, a therapeutic goal and the will of the capable patient; they are not the same as feeding by mouth, which is care. That is why they can be withheld or withdrawn when they bring no benefit or become disproportionate, and in that case care and comfort continue. The decision weighs more than others because food has great symbolic value and the family fears the patient will «starve to death». The page on limiting life-sustaining treatment gives the general framework; this page explains the situations specific to nutrition: the dying phase, advanced dementia and the persistent vegetative state.

Key facts

  • Types: enteral (nasogastric tube, gastrostomy) and parenteral (by vein). Food by mouth and assisted feeding are care, not artificial treatment.
  • Clear benefit: short-term critical care, digestive disease and chronic neurological disease with a good outlook.
  • Little or no benefit: the dying phase and advanced dementia with difficulty eating.
  • Burdens of the tube: discomfort, infections, repeated removal by the patient and the risk of physical restraint.
  • Nutrition can be stopped while hydration continues; in the dying phase, hydration can prolong and worsen the process of dying.
  • Voluntary refusal of food and fluids by a capable patient: it can be an autonomous decision; it is distinguished from severe depression and from illness-related loss of appetite.
  • Persistent vegetative state: advance directives or the patient's presumed will are sought.

In clinical practice

  • To a family afraid the patient will «starve», explain that at the end of life the body does not need food in the same way and that thirst is relieved with mouth care.
  • Use phrases such as «comfort feeding» rather than «stopping food».
  • Before a gastrostomy in advanced dementia, discuss hand feeding, the realistic goal and, if in doubt, a time-limited trial.
  • Record the goal, the review date and what will be done if the goal is not met.
  • Resolución 813 de 2026, art. 3.1: adjusting therapeutic effort (AET) means withdrawing or not starting activities, supplies, medicines, devices or treatments that are disproportionate or cause harm and suffering; it is not a euthanasia procedure.
  • Resolución 813 de 2026, art. 14: AET includes refusing life-support measures and means that replace biological functions; art. 17: the record states what is withdrawn, what continues for a set time, what continues indefinitely and what is not started, and symptom relief is guaranteed.
  • Resolución 813 de 2026, art. 5.5: therapeutic refusal means not authorizing, or asking to stop, a treatment even if it could benefit the patient.
  • The resolution does not expressly name artificial nutrition or hydration; its general rules of proportionality apply.
  • Official text checked on 2026-11-13 in Boletín Jurídico No. 04 de 2026 (section 2.2.6), minsalud.gov.co.

Test yourself

Think of the answer, then tap the question to see it.

What does artificial nutrition require according to the ESPEN ethics guideline?

A medical indication, a realistic therapeutic goal and the consent of the capable patient, because it is a medical intervention.

What comes first for a patient with advanced dementia who is eating less and less?

Careful hand feeding; a feeding tube does not improve the long-term outlook or reduce the risk of aspiration.

How is thirst relieved in a dying patient?

Mainly with care of the mouth and lips and small amounts of fluid; intravenous hydration does not always relieve it.

Is withdrawing artificial nutrition from a patient who refused it euthanasia?

No. It is adjusting therapeutic effort; Resolución 813 de 2026 (art. 3.1) states that AET is not a euthanasia procedure.

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Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.

Sources: ESPEN guideline on ethical aspects of artificial nutrition and hydration (Clin Nutr 2016;35:545-56) (European Society for Clinical Nutrition and Metabolism (ESPEN), 2016); Boletín Jurídico No. 04 de 2026, sección 2.2.6: Resolución 813 de 2026 (Ministerio de Salud y Protección Social, 2026); WMA Declaration of Venice on End of Life Medical Care (World Medical Association, 2022).

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