The question is whether or not a particular treatment or intervention will restore or enhance the quality of life for a particular patient
☛ if the answer is yes, and it can be justified on the best clinical grounds, then it is ethically right to do it
☛ if not, it should not be done
☛ ‘You have to do something!’ is never a justification for artificial hydration
Effects of dehydration in terminally ill patients
☛ dry mouth
↳ but this can be well palliated topically
☛ thirst
↳ although dying patients do not complain of thirst
☛ diminished conscious state
↳ several reports and a single randomized controlled trial showed no correlation between hydration and cognition in these patients
Possible benefits of dehydration in terminally ill patients
☛ less urine output means less movement and less incontinence
☛ less pulmonary secretions reduce dyspnoea and terminal congestion
☛ less gastrointestinal secretions will lessen nausea and diarrhoea
☛ less problems with oedema and effusions
Possible disadvantages of artificial hydration in terminally ill patients
☛ may have the opposite effects to the benefits listed above and worsen the patient’s situation
☛ may give an ambiguous signal or false hope to the patient or family
☛ drips act as a physical barrier between patient and family
Dehydration in patients not terminally ill
☛ causes thirst, dry mouth and postural hypotension
☛ patients unable to take or retain adequate fluids warrant parenteral hydration
Source:
The IAHPC Manual of Palliative Care 3rd Edition
https://web.archive.org/web/20210122105526/https://hospicecare.com/uploads/2013/9/The%20IAHPC%20Manual%20of%20Palliative%20Care%203e.pdf
