On withholding nutrition and hydration in the terminally ill.

[Argirios Argiriou]

J Med Ethics. 1995 June; 21(3): 141–143.

On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A reply.

R J Dunlop, J E Ellershaw, M J Baines, N Sykes, and C M Saunders


Abstract

Patients who are dying of cancer usually give up eating and then stop drinking. This raises ethical dilemmas about providing nutritional support and fluid replacement. The decision-making process should be based on a knowledge of the risks and benefits of giving or withholding treatments. There is no clear evidence that increased nutritional support or fluid therapy alters comfort, mental status or survival of patients who are dying. Rarely, subcutaneous fluid administration in the dying patient may be justified if the family remain distressed despite due consideration of the lack of medical benefit versus the risks. Some cancer patients who are not imminently dying become dehydrated from reversible conditions such as hypercalcaemia. This may mimic the effects of advanced cancer. These conditions should be sought and fluid replacement therapy should be given along with the specific treatments for the condition.

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[Denominator]

Εγώ εφάρμοζα ττην εξής εμπειρική αρχή σε ασθενείς τελικού σταδίου: Να μην πεθάνει κάποιος από αφυδάτωση ή από άλλη αναστρέψιμη με πολύ απλά μέσα και χειρισμούς αφορμή. Κατά τα άλλα, σε ασθενείς που διατηρούν επίπεδο συνείδησης, πάντα ρωτώ αν είναι επιθυμία τους να νοσηλευτούν και λαμβάνω την επιθυμία τους σοβαρά υπόψιν.
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