One of the biggest concerns expressed by families who are considering tube feeding is "I can't stand the thought of letting grandma starve to death because it will be painful". No one wants to make a heart-wrenching decision to withold food or fluid from a dying patient. However, there are times when this decision is in the best interests of a patient. An understanding of the physiological process of dying may help ease the burden of this decision. Studies indicate that dying patients who stop eating experience very little hunger. When food and fluid intake is poor, dehydration usually occurs before starvation. Dehydration eventually results in metabolic changes are said to produce a sedative effect on the brain just before death. Withholding fluids can reduce saliva, decrease the need to urinate, and reduce cough from congestion in the lungs, all of which can make a patient more comfortable. There may also be fewer requests for pain medication in a patient who is not recieving food and fluids.

Based on the evidence available, withholding food and fluids is not painful or uncomfortable. In fact, dehydration may actually increase comfort and minimize pain during the dying process.