Initiation or continuation of artificial hydration (AH) at the end of life requires unique considerations. A combination of ethical precedents and medical literature may provide clinical guidance on how to use AH at the end of life. The purpose of this review is to describe the ethical framework for and review current literature relating to the indications, benefits, and risks of AH at the end of life. Provider, patient, and family perspectives will also be discussed.
RousseauP. In: Management of symptoms in the actively dying patient. In: BergerAMPortenoyRKWeissmanDE eds. Principles and Practice of Palliative Care and Supportive Oncology. 2nd ed.Philadelphia, PA: Lippincott, Williams, & Wilkins; 2002.
2.
HuiDDevRBrueraE. The last days of life: symptom burden and impact on nutrition and hydration in cancer patients. Curr Opin Support Palliat Care. 2015;9(4):346-354.
3.
CasarettDKapoJCaplanA. Appropriate use of artificial nutrition and hydration—fundamental principles and recommendations. N Engl J Med. 2005; 353(24):2607-2612.
4.
VidalMHuiDWiliamsJBrueraE. A prospective study of hypodermoclysis performed by caregivers in the home setting. J Pain Symptom Manage. 2016;52(4):470.
5.
PiusXII. The prolongation of life: allocution to the international congress of anesthesiologists. Pope Speaks. 1958;4:393-397.
6.
BrodyHHermerLDScottLDArtificial nutrition and hydration: the evolution of ethics, evidence, and policy. J Gen Intern Med. 2011;26(9):1053-1058.
7.
BeauchampJTChildressJJ. The Belmont Report. Washington, DC: Department of Health, Education, and Welfare; 1979.
8.
LynnJ, ed. By No Extraordinary Means: The Choice to Forgo Life-Sustaining Food and Water. Bloomington: Indiana University Press; 1986.
9.
AnnasGJ. Nancy Cruzan and the right to die. N Engl J Med. 1990;323:670-673.
10.
DalalSDel FabbroEBrueraE. Is there a role for hydration at the end of life?Curr Opin Support Palliat Care. 2009;3(1):72-78.
11.
American Dietetic Association. Position of the American Dietetic Association: ethical and legal issues in nutrition, hydration, and feeding. J Am Diet Assoc. 2008;108(5):873-882.
12.
BrueraEFrancoJJMaltoniMWatanabeSSuarez-Almazor. Changing pattern of agitated impaired mental status in patients with advanced cancer: association with cognitive monitoring, hydration, and opioid rotation. J Pain Symptom Manage. 2005;10(4):287-291.
13.
BurgeF. Dehydration symptoms of palliative care cancer patients. J Pain Symptom Manage. 1993;8(7):454-464.
14.
MoritaTTeiYTsunodaJInoueSChiharaS. Determinants of the sensation of thirst in terminally ill cancer patients. Support Care Cancer. 2001;9(3):177-186.
15.
WallerAHershkowitzMAdunskyA. The effect of intravenous fluid infusion on blood and urine parameters of hydration and on state of consciousness in terminal cancer patients. Am J Hosp Palliat Care. 1994;11(6):22-27.
16.
McCannRHallWGroth-JunckerA. Comfort care for terminally ill patients: the appropriate use of nutrition and hydration. JAMA. 1994;272(16):1263-1266.
17.
MusgraveCFBartalNOpstadJ. The sensation of thirst in dying patients receiving i.v. hydration. J Palliat Care. 1995;11(4):17-21.
18.
MoritaTTieYInoueS. Agitated terminal delirium and association with partial opioid substitution and hydration. J Palliat Med. 2003;6(4):557-563.
19.
CerchiettiLNaviganteASauriAPalazzoF. Hypodermoclysis for control of dehydration in terminal-stage cancer. Int J Palliat Nurs. 2000;6(8):370-374.
20.
BrueraESalaRRicoMAEffects of parenteral hydration in terminally ill cancer patients: a preliminary study. J Clin Oncol. 2005;23(10):2366-2371.
21.
BrueraEHuiDDalalSParenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol. 2013;31(1):111-118.
22.
RaijmakersNJHvan ZuylenLCostantiniMArtificial nutrition and hydration in the last week of life in cancer patients: a systematic literature review of practices and effects. Ann Oncol. 2011;22(7):1478-1486.
23.
GoodPRichardRSyrmisWJenkins-MarshSStephensJ. Medically assisted hydration for adult palliative care patients. Cochrane Database Syst Rev. 2014;4:CD006273.
24.
BrueraEBelzileMWatanabeSFainsingerRL. Volume of hydration in terminal cancer patients. Support Care Cancer. 1996;4(2):147-150.
25.
MoritaTShimaYAdachiIJapan Palliative Oncology Study (J-POS) Group. Attitudes toward terminal dehydration of Japanese physicians: a nationwide survey. J Clin Oncol. 2002;20(24):4699-4704.
26.
MiyashitaMMoritaTShimaYKimuraRTakahashiMAdachiI. Physician and nurse attitudes toward artificial hydration for terminally ill cancer patients in Japan: results of 2 nationwide surveys. Am J Hospice Palliat Med. 2007;24(5):383-389.
27.
HuiDDevRBrueraE. The last days of life: symptom burden and impact on nutrition and hydration in cancer patients. Curr Opin Support Palliat Care. 2015;9(4):346.
28.
DevRDalalSBrueraE. Is there a role for parenteral nutrition or hydration at the end of life?Curr Opin Support Palliat Care. 2012;6(3):365-370.
29.
MercadanteSFerreraPGirelliDCasuccioA. Patients’ and relatives’ perceptions about intravenous and subcutaneous hydration. J Pain Symptom Manage. 2005;30(4):354-358.
30.
GentMJFradshamSWhyteGMMaylandCR. What influences attitudes towards clinically assisted hydration in the care of dying patients? A review of the literature. BMJ Support Palliat Care. 2013;5(2):223-231.
31.
BrodyHHermerLDScottLDGrumblesLLKutacJEMcCammonSD. Artificial nutrition and hydration: the evolution of ethics, evidence, and policy. J Gen Intern Med. 2011;26(9):1053-1058.
32.
A.S.P.E.N. Ethics Position Paper Task Force. A.S.P.E.N. ethics position paper. Nutr Clin Pract. 2010;25(6):672-679.