Dehydration in the terminally ill--iatrogenic insult or natural process?

The question of whether terminally ill patients should artificially be given fluids has been debated since before palliative care became a recognised specialty. Arguments have been adduced from physiological, comfort, legal psychological, and emotional perspectives. Palliative care specialists agree that the priority is preventing the symptoms associated with dehydration, rather than the dehydration itself. However, the majority of terminally ill patients are cared for in settings outside hospices, and those admitted to hospital will tend to be exposed to a more technical approach. There are no randomised controlled trials in this area, and although an ethical minefield, we should not be afraid to manage individual patients according to the principles of palliative care where control of symptoms, not normalising of physiological variables, is the primary objective.