ON WITHHOLDING NUTRITION AND HYDRATION IN THE TERMINALLY ILL - HAS PALLIATIVE MEDICINE GONE TOO FAR - A REPLY

Patients who are dying of cancer usually give up eating and then stop drinking. This raises ethical dilemmas about providing nutritional sup port and fluid replacement. The decision-making process should be base d on a knowledge of the risks and benefits of giving or withholding tr eatments. There is no clear evidence that increased nutritional suppor t or fluid therapy alters comfort, mental status or survival of patien ts who are dying. Rarefy, subcutaneous fluid administration in the dyi ng patient may be justified if the family remain distressed despite du e consideration of the lack of medical benefit versus the risks. Some cancer patients who are not imminently dying become dehydrated from re versible conditions such as hypercalcaemia. This may mimic the effects of advanced cancer. These conditions should be sought and fluid repla cement therapy should be given along with the specific treatments for the condition.