The case highlighted in this article is interesting and important (see Case scenario box). It refers to a clinical decision to withhold artificial hydration from a patient at the very end stages of multiple sclerosis. The withholding of fluids and food from a dying patient is not something about which everyone feels comfortable. There was disagreement within the multidisciplinary team regarding the decision not to hydrate the patient. The case exposes the problem of managing disagreement within a multidisciplinary team. Earlier legal/ethical examinations in this series discussed the importance of reasoning one’s way through a case, to separate in one’s mind facts (i.e. what is happening, what is being claimed, what is known from evidence, what standards of practice apply, what does the law state?) from the values that are applied to the situation (i.e. how one decides what is good or bad and what one ought, or ought not to do). This is a case where the above mental process is an essential exercise. The article will outline the legal aspects of the case, before discussing the ethical implications. Conflicts of interest: none
- Artificial hydration
- End-of-life care
- Ethical decision-making
- Reasonable standard of care
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