Artificial hydration: the role of the nurse in addressing patient and family needs

When caring for terminally ill patients and their families, nurses are confronted with the subject of terminal dehydration and the question of artificial hydration at the end of life. Terminal dehydration and artificial hydration are still controversial topics of discussion and, to this day, data remain insufficient to reach a final conclusion on the benefits or harm of dehydration in terminally ill patients (Ersek, 2003; Fainsinger, 2008). Nurses, just like physicians, have different attitudes about the usefulness of artificial hydration. Personal and professional experiences, cultural influences, and the place of care, as well as education and available resources, are guiding clinical practice (Morita et al, 2002; Pasman et al, 2004). Since there is no ethically or medically based gold standard, each decision for or against hydration at the end of life needs to be taken on an individual basis. This article reflects on the meaning of dehydration for the patient and their family, and reviews the role of the nurse within the decision-making process. Arguments for or against artificial hydration are illuminated through patient situations which took place in the clinical setting of a hospice. The article further highlights the importance of recognising dehydration in frail and elderly patients, and critically assesses policies that may hinder its optimal palliation in different settings in Switzerland.