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Nutrition and Hydration

Providing food and fluids has great meaning to many people as they often relate the provision of food and fluids to comfort and nourishment, and to the giving and preserving of life. A person’s cultural background can have great impact on their values and beliefs regarding this topic and should never be underestimated.

Providing food and fluids for as long as someone wants them and can safely take them is important. It is when the person can no longer take them that the complexities of ethical decision making arise. This can be an emotive issue for nurses as well as for families.

Some family members insist on trying to continue to feed their loved one even when it is no longer safe to do so. They may consider not doing this as a failure to care. They may also insist on parenteral fluids or a feeding tube once someone can no longer eat or drink. In these circumstances it is important to talk to them about comfort measures, such as regular mouth care, wetting the patient's lips and using lip balms. If the family are so distressed at the thought of dehydration, a small amount of subcutaneous fluid may be an acceptable compromise.

Other health professionals are a good resource. For example, if unsure whether someone can still safely swallow food and fluids, referral to a speech therapist would be helpful.

Some patients themselves choose to specifically request not to receive artificial nutrition or hydration at the end of their life, such as in an advance directive. Some may make this choice at the time, with or without the agreement of their relatives.

Artificial nutrition and hydration are seen by some as interventions in what should be a natural process. They may be easy to initiate but there can be difficulties when the time comes to consider their withdrawal. All discussions should take place early with families, ensuring they are aware of burdens and benefits of continuing this therapy.

Resources

Websites
  • 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.
  • The Canadian Virtual Hospice has questions and answers from their consumer section on Nutrition.
Guidelines / Documents / Factsheets Videos / Podcasts

Related CareSearch Pages

Nurses Hub
Communication
Advanced Care Planning
Working with Families
Symptom Management
Withdrawing and Withholding Treatment
Autonomy

GP Resources Page
Communication

For Patients, Carers and Families
Why is Communication Important

CareSearch Review Collection
Fluids and Hydration

PubMed Topic Search
Artificial Nutrition

Free Full Text Articles

Good P, Richard R, Syrmis W, Jenkins-Marsh S, Stephens J. Medically assisted hydration for adult palliative care patients. Cochrane Database Syst Rev. 2014 Apr 23;4:CD006273

Good P, Richard R, Syrmis W, Jenkins-Marsh S, Stephens J. Medically assisted nutrition for adult palliative care patients. Cochrane Database Syst Rev. 2014 Apr 23;4:CD006274.

Ong WY, Yee CM, Lee A. Ethical dilemmas in the care of cancer patients near the end of life. Singapore Med J. 2012 Jan;53(1):11-6.

Brody H, Hermer LD, Scott LD, Grumbles LL, Kutac JE, McCammon SD. Artificial nutrition and hydration: the evolution of ethics, evidence, and policy. J Gen Intern Med. 2011 Sep;26(9):1053-8. Epub 2011 Mar 5.

Palecek EJ, Teno JM, Casarett DJ, Hanson LC, Rhodes RL, Mitchell SL. Comfort feeding only: a proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia. J Am Geriatr Soc. 2010 Mar;58(3):580-4.

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

Note: The Cochrane Library provides free online access for residents of particular countries through a national funded licence.

Relevant Studies

Stiles E. Providing artificial nutrition and hydration in palliative care. Nurs Stand. 2013 Jan 16-22;27(20):35-42.
 
Buck HG. Refusing artificial nutrition and hydration in advanced illness. Nursing. 2012 Sep;42(9):12-3. No abstract available.
 
Del Río MI, Shand B, Bonati P, Palma A, Maldonado A, Taboada P, et al. Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff. Psychooncology. 2012 Sep;21(9):913-21. Epub 2011 Dec 8.

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.

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.

McClement SE, Harlos M. When advanced cancer patients won't eat: family responses. Int J Palliat Nurs. 2008 Apr;14(4):182-8.

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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Last updated 22 May 2014*