The Last Days of Life
Most people stop eating and drinking in the last days of life.
- The person is given food or drink when they don’t want it or cannot physically manage to swallow and experiences unnecessary suffering.
- The person’s decision-making capacity is not properly understood, and they continue to be fed or hydrated against their wishes.
- The person does not know that they can refuse food or drink and feels compelled to continue to eat and drink when they don’t want to.
- Know whether the person has an Advance Care Directive or other advance care planning documents and check their decisions about nutrition and hydration supports.
- Ensure advance care planning documents, and recorded decisions and refusals about eating and drinking are available to all care staff to inform delivery of care.
- Educate and empower staff about the process of dying so they understand refusal of food and drink is a common and expected part of the dying process.
- Undertake reflective practice to assess staff understanding of nutrition and hydration at the end of life.
- Check in with the person (and others involved in decision-making relating to their care) that they have the information they need to make decisions, and that they feel heard.
Food and drink should continue to be provided for as long as the person wants and can safely tolerate it. 11 However, it is common for a person in the final days of their life to lose interest in and stop eating and drinking.
A person with decision-making capacity has the legal right to refuse food and drinks or artificial nutrition or hydration (even if this results in their death). Their refusal should be respected.
The person may have given directions about providing, withholding or withdrawing nutrition and hydration in their Advance Care Directive. A valid directive will operate once a person has lost capacity (except in the Australian Capital Territory, where it is effective both when the person has and does not have capacity). In Queensland, a refusal of artificial hydration or nutrition in an Advance Health Directive can only be followed in certain circumstances.
When a person stops eating and drinking, medication can be given to reduce associated pain or symptoms. Measures such as appropriate oral care (e.g. offering ice to suck on, swabs to moisten their lips, apply lip balm) can provide comfort.
Health professions can withhold futile or non-beneficial supports
It is lawful for health professionals to withhold or withdraw artificial nutrition or hydration if starting or continuing it would be futile or non-beneficial. Although consent is not required (except in Queensland), it is good practice for health professionals to engage in shared decision-making about this with the person (if the person has capacity) or the person’s substitute decision-maker (if the person lacks capacity).