Clinical Case Database / Category: Patient Management
Food and fluid at the end of life
Sarah K Wilcox MBChB, BSc Hons, MRCP, Suzanne Kite MbChB, BMedSci, MA, FRCP (London)
Foundation Years Journal, volume 3, issue 9, p.42 (123Doc Education, London, November 2010)
In some patients, artificial nutrition and hydration (ANH) can improve general well-being and prolong life (1). However, in patients with a life-limiting illness, ANH could potentially prolong suffering. In dying patients, the burden of ANH can often outweigh any medical benefits. This article uses a case to illustrate some of the clinical considerations around ANH at the end of life and reviews the available evidence. In the context of this article "end of life" refers to the last days of life.
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Sarah K Wilcox MBChB, BSc Hons, MRCP
Specialist Registrar in Palliative Medicine
Suzanne Kite MbChB, BMedSci, MA, FRCP (London)
Consultant in Palliative Medicine
The Leeds Teaching Hospitals Trust
1. Artificial Nutrition and Hydration: Guidance in End of Life Care for Adults. National Council for Palliative Care joint publication with the Association for Palliative Medicine May 2007.
2. Lichter I. Weakness in Terminal Illness, Palliative Medicine, 1990, 4:73â€“80.
3. Davis M et al. Appetite and Cancer-Associated Anorexia: A review. Journal of Clinical Oncology, 2004, 8:1510â€“1517.
4. Steiner N and Bruera E. Methods of Hydration in Palliative Care Patients. Journal of Palliative Care, 1998, 14(2):6â€“13.
5. Morita T, Hyodo I, Yoshima T, et al. Artificial hydration therapy, laboratory findings and fluid balance in terminally ill patients with abdominal malignancies. Journal of pain and Symptom Management, 2006, 31(2):130â€“138.
6. Ellershaw JE, Sutcliffe JM and Saunders CM. Dehydration and the dying patient. Journal of Pain and Symptom Management, 1995, 10(3):192â€“197.
7. McCann, RM et al. Comfort Care for Terminally Ill Patients: The Appropriate use of nutrition and hydration. JAMA, 1994, 272:1263â€“1266.
8. General Medical Council (2002). Withdrawing and withholding life-prolonging treatments: Good practice in decision making. London: GMC.
9. British Medical Association guideline: Withdrawing and withholding artificial nutrition and hydration, 3rd edition. London. March 2007. BMA.
10. Burke versus General Medical Council 
11. Assessment of Mental Capacity: Guidance for Doctors and Lawyers. London 2005. The Law Society/BMA. BMJ Books.
12. Airedale NHS Trust versus Bland  1 ALL ER 821â€“896.
13. Gillick M. The New England Journal of Medicine, 2000, 342(3):206â€“211.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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