Dehydration and provision of fluids in palliative care. What is the evidence?

OBJECTIVE

To provide a clinical review of issues surrounding reduced fluid intake in palliative care patients and a practical approach to care for these patients.

DATA SOURCES

Medline was searched from 1980 to 1995 for articles concerning dehydration in dying patients. In addition, the law databases QUICKLAW, WESTLAW, and MEDMAL were searched.

STUDY SELECTION

Key papers were included for discussion in relation to the clinical evidence to treat or withhold treatment and to a representative sample of the social, ethical, and legal issues.

SYNTHESIS

There is little clinical evidence to guide patients, families, or clinicians in treating with reduced fluid intake during the terminal phase of life. Assisting patients to take fluids as a social or symbolic act is recognized, as is the ethical and legal stance that assisting fluid intake should be thought of as a medical therapy.

CONCLUSION

Without sound evidence upon which to base clinical decisions, patients, families, and clinicians are left to balance potential benefits and burdens against the goals of care.