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Issues relating to nutrition and hydration at end of life
  1. Helen Scott, Editor End of Life Care, Bank Staff Nurse
  1. St Christopher’s Hospice, and currently undertaking an MSc in Palliative Care, King’s College London

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The personal narrative in this issue (pages 64–65) is a stark reminder of the despair relatives/friends experience when they perceive care and communication at the end of life to be inadequate. Cessation of active management can be considered abandonment, especially when dying patients are made ‘nil by mouth’. The provision of food and fluids at the end of life requires examination in the light of new guidance from the Royal College of Physicians (RCP, 2010) and General Medical Council (GMC, 2010). First, it needs to be clarified that oral hydration and nutrition provision is part of ‘basic care’. The law defines basic care as essential procedures which maintain comfort, e.g. pain and symptom relief, prevention of pressure ulcers, hygiene measures and provision of oral nutrition and/or hydration. Basic care provision is mandatory (Law Commission, 1995). Patients have a legal right to oral nutrition and fluid, …

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