In terminally ill patients at home on hospice, what is a key rationale for not relying on enteral feeding to ensure comfort?

• A. Hydration completely eliminates symptoms
• B. Starvation leads to ketosis causing euphoria
• C. Small amounts of feeding can prevent ketosis and prolong hunger
• D. EN will always prolong life

Answer: (C)

In hospice care, the central aim is comfort and symptom relief, not to sustain life with artificial feeding. When intake is low, the body naturally shifts to ketosis as part of the metabolic response to reduced nutrition. Allowing this natural progression can be more aligned with comfort goals and avoids the burdens that enteral feeding can introduce, such as fullness, GI distress, or risk of aspiration. The idea reflected in the correct option is that providing even small amounts of enteral nutrition can alter that metabolic trajectory by preventing ketosis, which could unintentionally prolong the dying process and increase treatment burden. Therefore, withholding enteral feeding is often chosen to preserve comfort and minimize interventions at the end of life.