Letter to the Editor

Dehydration: Therapeutic at the End of Life

Authors: Steven Lippmann, MD

Abstract

To the Editor: Maintaining hydration is an important healthcare principle. Addressing patient hydration is an established goal in medicine.1 Physical and emotional health are enhanced by proper fluid and electrolyte balance. There also is a universal wish to extend enjoyable lives, but not to prolong unpleasant deaths.1–16 

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Burge FL. Dehydration and provision of fluids and palliative care. What is the evidence? Can Family Phys 1996;42:2383–2388.
 
2. Printz LA. Is withholding hydration a valid comfort measure in the terminally ill? Geriatrics 1998;43:48–88.
 
3. Andrews MR, Levine AM. Dehydration in the terminally ill patient: perception of hospice nurses. Am J Hospice Palliat Med 1989;6:31–34.
 
4. Bernat JL, Gurt B, Mogleniciki RP. Patient refusal of hydration and nutrition: an alternative to physician-assisted suicide or voluntary active euthanasia. Arch Intern Med 1993;153:2723–2728.
 
5. Radbruch L, De Lima l. International Association for Hospice and Palliative Care response regarding voluntary cessation of food and water. J Palliat Med 2017;20:578–579.
 
6. Brar K, Lippmann S. Dehydration in terminal illness: which pathway forward? J Family Pract 2018;67:E1–E3.
 
7. Sullivan RJ. Accepting death without artificial nutrition or hydration. J Gen Intern Med 1993; 8:220–224.
 
8. Lippmann S. Palliative dehydration. Prim Care Companion CNS Disord 2015;17:10.4088/ PCC.15 l01797.
 
9. Baracos V. International Association for Hospice and Palliative Care endorses volitional death by starvation and dehydration. J Palliat Med 2017; 20:577.
 
10. Bruera E, Hul D, Dalal S, et al. Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol 2013;31:111–118.
 
11. Bailey FA, Harman SH. Palliative care: the last hours and days of life, https://www.uptodate.com. Published 2014. Accessed August 12, 2021.
 
12. Miller PG, Meler DE. Voluntary death: a comparison of terminal dehydration and physician-assisted suicide. Ann Intern Med 1988;128:559–562.
 
13. Forrow L, Smith HS. Pain management and of life: palliative care. In: Warfield CA, Bajwa ZH, eds. Principles and Practices of Pain Management, 2nd ed. New York: McGrawHill; 2004.
 
14. Zerwekh JV. The dehydration question. Nursing 1983;13:47–51.
 
15. De Lima L,Woodruff R, Pettus K, et al. International Association of Hospice and Palliative Care position statement: euthanasia and physicianassisted suicide. J Palliat Med 2017;20:8–14.
 
16. Suchner U, Reudelsterz C, Gog C. How to manage terminal dehydration. Anaesthesist 2019; 68(suppl 1):S63–S75.