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.