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Withholding and withdrawing artificial nutrition/hydration
  1. Hildegard Kolb
  1. Hildegard Kolb is Staff Nurse, The Ayrshire Hospice, Ayr


When a patient approaches the end of life, healthcare professionals are faced with a number of ethical issues relating to the decision to withhold (not start) or withdraw (stop) treatment. These include whether life should be maintained at all costs, using all available means, even if the treatment is a great burden for the patient, or whether it is preferable to accept the imminence of death and focus on the patient’s comfort. Ethical principles can help professionals, the patient and loved ones weigh up the benefits, burdens and risks of a specific treatment. Today’s healthcare system considers artificial nutrition and hydration (ANH) to be a major life-sustaining treatment, but opinions over this are divided. Research shows that ANH is not always beneficial to patients when they have stopped oral intake. On the contrary, it has been found that caloric deprivation and terminal dehydration provide a number of benefits for the patient. This article will discuss the dilemmas that confront practitioners in relation to withholding and withdrawing treatment, in particular ANH, at the end of a patient’s life. Conflicts of interest: none

  • Artificial nutrition and
  • hydration
  • Ethical decision-making
  • Palliative and end-of-life care
  • Principle of double effect

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