What is the role of clinically assisted hydration in the last days of life?
BMJ 2023; 380 doi: https://doi.org/10.1136/bmj-2022-072116 (Published 17 March 2023) Cite this as: BMJ 2023;380:e072116
- Andrew Davies
, professor of palliative medicine, consultant in palliative medicine1, - Caroline Barry, clinical associate professor in translational and clinical medicine; consultant in palliative medicine2,
- Stephen Barclay, professor of palliative care; general practitioner3
- 1Trinity College Dublin, University College Dublin, and Our Lady’s Hospice, Dublin, Republic of Ireland; University of Surrey, Guildford, UK
- 2Norfolk and Norwich University Hospitals, and University of East Anglia, Norwich, UK
- 3University of Cambridge, Cambridge, UK
- Correspondence to: A Davies andavies{at}tcd.ie
What you need to know
Decisions about the provision of clinically assisted hydration to patients in their last days of life are complex and should always be individualised
Evidence is lacking about the potential benefits and harms of clinically assisted hydration in the last days of life
Clinical guidelines are available to support decision making and need to be used in conjunction with relevant national ethical and legal frameworks
Clinically assisted hydration, also known as medically assisted hydration, is the process by which “fluids” are given parenterally via a cannula (either intravenously or subcutaneously) or enterally via a tube (into the stomach or small bowel or, less commonly, into the rectum). Decisions about the role of clinically assisted hydration in the last days of life are often complex and can have a major impact on the dying patient, as well as their loved ones and clinical staff. These challenging clinical decisions must be made with high degrees of uncertainty due to a paucity of evidence. This article summarises the evidence base for clinically assisted hydration in the last days of life and offers suggestions for clinical practice in light of these uncertainties.
Possible benefits and harms of clinically assisted hydration in the last days of life are varied. Proposed benefits include patient comfort (such as prevention of thirst and dry mouth) and the maintenance of renal perfusion with prevention of accumulation of toxins and drugs (prevention of delirium and opioid toxicity).1 Delirium is a common problem at the end of life and is the cause of much distress to patients, their loved ones, and clinical staff. Possible harms of hydration include fluid overload (such as worsening of peripheral oedema and cardiac failure), fluid related complications (such as worsening of vomiting and respiratory secretions),1 and medicalisation of the normal dying process. Some commentators even …