Dunlop R J, Ellershaw J E, Baines M J, Sykes N, Saunders C M
St Christopher's Hospice, London.
J Med Ethics. 1995 Jun;21(3):141-3. doi: 10.1136/jme.21.3.141.
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.
濒临死亡的癌症患者通常会停止进食，随后停止饮水。这引发了关于提供营养支持和液体补充的伦理困境。决策过程应基于对给予或 withholding 治疗的风险和益处的了解。没有明确证据表明增加营养支持或液体疗法会改变濒死患者的舒适度、精神状态或生存期。极少数情况下，如果尽管充分考虑了缺乏医疗益处与风险，但家属仍感到痛苦，那么对濒死患者进行皮下补液可能是合理的。一些并非濒临死亡的癌症患者会因高钙血症等可逆性病症而脱水。这可能会模拟晚期癌症的影响。应排查这些病症，并在针对该病症进行特定治疗的同时给予液体替代疗法。 （注：原文中“withholding”未翻译完整，推测可能是“ withholding treatment”即“ withholding治疗”，翻译为“ withholding”可能是想表达“不给予”之类的意思，但这样在句中不太通顺，最好能确认一下原文准确内容。）
