“He Said He Wouldn’t Want This”: Is Minimal Comfort Feeding Viable?

If you will be at AAHPM in Denver in in February 2025, be sure to check out this session on Saturday at 11:15 - “He Said He Wouldn’t Want This”: Is Minimal Comfort Feeding Viable? 

• Author Presenting: Hope Wechkin, MD, FAAHPM, HMDC – EvergreenHealth Home Care Services
• Author Presenting: Chris Clement, MSW LICSW APHSW-C – EvergreenHealth Home Care Services
• Author Presenting: Cathy Scarcello, RN, BSN – Kaiser Permanente Hospice
• Author Presenting: Nathan Yemane, MSW, LICSW – Heart n Soul Hospice
• Author Presenting: Robert Macauley, MD – OHSU
• Author Presenting: Elizabeth DT Loggers, MD, PhD, FAAHPM – Fred Hutchinson Cancer Center

This session will expand on this recent article in JPSM: "“Mr. Smith Has No Mealtimes”: Minimal Comfort Feeding for Patients with Advanced Dementia."

While Comfort Feeding Only is appropriate for patients with advanced dementia, its emphasis on assiduous hand-feeding that may prolong life for years fails to accommodate the preferences of those who do not want to continue living with this illness. Some have proposed advance directives to completely halt the provision of oral nutrition and hydration once a person has reached an advanced stage of dementia. However, these directives may fail to address patients’ discomfort, caregivers’ obligations, or current care and regulatory standards when patients reside in facilities. 

In response to these dilemmas, we introduce Minimal Comfort Feeding (MCF). Rather than offering food and liquids proactively as with Comfort Feeding Only, caregivers provide nutrition and hydration only in response to signs of hunger and thirst. While further study is required to define and negotiate challenges in operationalizing this approach, MCF provides a framework that resolves competing ethical and clinical considerations in caring for those with advanced dementia.