QUESTION: Is a diagnosis of "Failure to Thrive" a choice on the part of the patient when they consciously refuse to eat?
I’m not sure that most people “consciously” refuse to eat. We tend to think the elderly and those very sick are making a choice, generally they are not. Their body is shutting down and the body, not the personality, just can’t eat anymore. Remember it is food that holds us on this planet and if the body is preparing to die, to let go, it will gradually stop eating. No choice is involved here
There are some people, few, but some, who consciously decide to stop eating so that they can die. People with a poor prognosis, a life threatening illness, people in pain with no cure insight, people who feel not eating is the only control they now have in their life. These people will sometimes make the choice to not eat. If we don’t eat we will die.
What do we do about this not eating, on purpose or just the shutting down of the body? We always, always offer food. My suggestion is if a person has been told they can’t be fixed and entering the dying process don’t force them to eat. Offer, but don’t go the artificial feeding path. Offer them high protein snacks (4-6 a day) also offer them 4 ounces of a liquid protein supplement every 2 hours. The operative word here is offer. You will not stop the non eating progression but you may buy a bit of time and energy.
The person will die from the disease progress not because they didn’t get enough calories. We tend to think a person with a life threatening illness who doesn’t eat dies of starvation when in reality a person dies from the disease progression and not eating is an off shoot of the disease progression. Yes, most people do not take enough calories for maintaining a body as they approach death from disease or old age, that is part of the normal dying process.
By artificially feeding them with TPN or tube feedings we do not reverse the terminal disease progression, we don’t stop it or even slow it down. The person will die either way. It is just that they will die having had one more medical procedure, one more disruption to their body generally with more discomfort.
Something More about Eating and Not Eating as End of Life Approaches..
The award winning New Rules for End of Life Care DVD Kit guides you through eating, sleeping and pain management. This can be very helpful for families learning about the dying process.