Thursday, July 12, 2007
This presentation is part of : Chronic Care Initiatives
Does the provision and non-provision of medical nutrition and hydration at the end stage of life cause patient suffering?
Pamela Jane Van der Riet, PhD, MEd, BA, RN1, Isabel Higgins1, milly Sneesby2, and Phillip Good3. (1) Nursing and Midwifery, University of Newcastle, Callaghan, Australia, (2) Nursing, Mater Hospital, Newcastle, Australia, (3) Medicine, Mater Hospital, Newcastle, Australia
Learning Objective #1: Identify the benefits of terminal dehydration for dying patients
Learning Objective #2: Explain ways to manage the effects of terminal dehydration

Less than a century ago it was normal practice as part of the dying process for there to be a gradual decrease in oral intake. Nowadays with the advent of technology the possibilities are endless and in medicalising dying there is a prevailing heroic discourse. There is also   tension in these practices and the question has to be asked, “is it in the best interests of the dying patient to medically hydrate?”

This presentation draws upon data from a qualitative study which examined Palliative Care nurses’ and doctors’ perceptions and attitudes to patient nutrition and hydration at the end of life. This study indicates that these health professionals believe that patients are not hungry or thirsty and providing adequate mouth care is given, patients do not suffer from terminal dehydration.   The view of the eighteen health professionals in this study was that terminal dehydration was a normal part of the process of dying for it   lessened the burden of suffering by offering   relief from symptoms of fluid overload. Patients’ breathing was easier and there was less edema.  Further benefits identified in this study included less need for catheters,   reduced urinary frequency, therefore, less excoriation, and   better hygiene. Patients with cerebral tumors benefited as terminal dehydration reduced cerebral edema, therefore, there were less headaches and. drowsiness. Reduced drowsiness meant patients were able to communicate with family and friends.    Vomiting was reduced, particularly if patients are suffering a gastrointestinal obstruction. 

The lessened use of   technology provided an environment in which patients experienced closer   emotional contact with family and health professionals.  The overall view from participants in this study was that there was a better management regime for patients that was more consistent with the palliative care   ethos of promoting comfort and lessening the burden of suffering.