What happens when one forgoes food and fluids at the end of life?

• Starvation? No:  Starvation is a long, drawn out (and typically painful) process that can take anywhere from 30 to 60 days to run its course.  Dying patients who stop taking in food and fluids do not starve to death. 
  
  
• Dehydration:  While the body can sustain itself for up to two months without food, it can sustain itself no more than about two weeks (at most) without fluid intake.  Unlike starvation, however, dehydration is typically not a painful or even an uncomfortable process, especially when good comfort care measures and undertaken.  In fact, many patients report less discomfort and there is less request for pain medication as dehydration runs its course.
   
  
• The dying process:  Patients who stop taking in food and fluids drift into a state of unconsciousness.  This phase of the process may take from 5 to 8 days if the patient is fully hydrated when food and fluid intake is stopped.  Patients will typically die peacefully several days after that.   If the patient is already partly dehydrated when fluid intake is stopped, the dying process will be compressed and may only last a couple of days, or less.
  
  
• Nature's course:  Dehydration is a natural part of the dying process.  It tended to be an indirect cause of most natural deaths (those not associated with violent trauma or acute infection) before the widespread use of tube feeding began in the 1960s and 1970s.   Even today, it is generally accepted that food intake decreases naturally with age and that often elderly people report a decrease in appetite as they progress toward the end of life. 

Citations

Ahronheim, Judith C., and Gasner, M. R.  1990.  "The Sloganism of Starvation." The Lancet.  Vol. 335, pp. 278-279. 

Cranford, Ronald E.  1991. "Neurological Syndromes and Prolonged Survival: When CanArtificial Nutrition and Hydration be Foregone?" Law, Medicine, and Health Care.  Vol. 19, pp. 13-22.

Justice, Christopher. 1995.  "The ‘Natural’ Death While Not Eating: A Type of Palliative Care in Banaras, India," Journal of Palliative Care.  Vol. 11, pp. 38-42.

Lynn, Joanne, and Harrold, Joan.  2001.  Handbook for Mortals: Guidance for People Facing Serious Illness.  New York: Oxford University Press, pp. 129-138.

Meares, Candace Jans.  1994.  "Terminal Dehydration: A Review," The American Journal of Hospice and Palliative Care. Vol. 11, pp. 10-14. 

Shils, Maurice E., Olson, James A., and Shike, Moshe, eds. 1994. Modern Nutrition in Health and Disease. 8th ed.  Philadelphia: Lea and Febiger. 

Sullivan, Robert J.  1993.  "Accepting Death without Artificial Nutrition and Hydration," Journal of General Internal Medicine. Vol. 8, pp. 220-224.