A long contended issue in palliative care is that of providing or withholding food and fluids at the end of life. Providing food and fluids is an emotive issue and has great meaning to many people, often relating to comfort and nourishment and to the giving of life. Cultural background and ethnicity can greatly impact on values and beliefs regarding this topic and can never be underestimated.

Providing food and fluids for as long as someone wants them and can safely take them (ie, if they can still swallow) is important. However, some families will insist on trying to continue to feed someone even when it is no longer safe (eg, they are choking). They may see anything other than that as a failure to care. They may also insist on intravenous fluids or artificial feeding (eg, PEG) once someone can no longer eat or drink. In these circumstances talk to them about comfort measures, such as regular mouth care, wetting the patient's lips and using lip balms.

Other health professionals are a good resource, for example if unsure whether someone can still manage food and fluids referral to a speech therapist (if able to access) would be helpful.

The use of artificial nutrition and hydration are seen by some as interventions in what should be a natural process. They are often easy to initiate but there can be difficulties when the time comes to discuss their withdrawal. All discussions should take place early with families, ensuring they are aware of all the implications.

Resources

• NSW Health has produced Guidelines for end-of-life care and decision-making
• Presentation from Palliative Care Australia’s Guidelines for a Palliative Approach in Residential Aged Care: Nutrition and Hydration – A palliative Approach to Care 
• Current Learning In Palliative care: Decisions in nutrition and hydration 
• Podcast from the International Program of Psycho-social Health research Terminal Dehydration: The Experience and Perceptions of End-Of-Life Palliative Care Nutrition and Hydration 
• Fact Sheet from the Caring Connections website (US) on Artificial Nutrition (food) and Hydration (fluids) at the End of Life 
• The Canadian Virtual Hospice has Questions and Answers from their consumer section on Nutrition 
• The International Association of Hospice and Palliative care IAHPC Manual of Palliative Care 2nd Edition has a section on Ethical Issues. 
• The Center for Bioethics, University of Minnesota (US) has a document: End of Life Care: An Ethical Overview 
• The Southern Cross Bioethics Institute website provides access to information on bioethical legislation in Australia, much of which is relevant to palliative care It can be different in each State and Territory, such as the Consent to Medical Treatment and Palliative Care Act 1995 (SA) and the Medical Treatment Act 1994 (ACT).
• The General Medical Council in the UK has produced a guidance for doctors that may be of interest: Treatment and Care Towards the End of Life – Good practice in decision-making.

Related CareSearch pages

Nurses Hub
Communication
Advanced Care Planning
Working with Families
Symptom Management

GP Pages
Communication

For Patients and Families
Comunication

CareSearch Review Collection
Fluids and Hydration

PubMed Topic Search
Artificial Nutrition

Free Full Text Articles

Ashby MA, Mendelson D. Gardner; re BWV: Victorian Supreme Court makes landmark Australian ruling on tube feeding. Med J Aust. 2004 Oct 18;181(8):442-5.

Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007209.

Good P, Cavenagh J, Mather M, Ravenscroft P. Medically assisted nutrition for palliative care in adult patients. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD006274.

Good P, Cavenagh J, Mather M, Ravenscroft P. Medically assisted hydration for adult palliative care patients. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD006273.

References

1. Bryon E, Gastmans C, de Casterlé BD. Decision-making about artificial feeding in end-of-life care: literature review. J Adv Nurs. 2008 Jul;63(1):2-14. Epub 2008 Jul 1.
2. Good P, Cavenagh J, Mather M, Ravenscroft P. Medically assisted hydration for adult palliative care patients. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD006273. 
3. McClement SE, Harlos M. When advanced cancer patients won't eat: family responses. Int J Palliat Nurs. 2008 Apr;14(4):182-8. 
4. Schmidlin E. Artificial hydration: the role of the nurse in addressing patient and family needs. Int J Palliat Nurs. 2008 Oct;14(10):485-9.

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This page was created on 27 August 2010
Last updated 27 August 2010*