A discourse analysis of difficult clinical situations in relation to nutrition and hydration during end of life care

Abstract

Medical and nursing staff have different attitudes and beliefs towards end of life care. Tensions arise when decisions need to be made based on quality of life or prolongation of life. The successful merging of curative and palliative care is not without challenges. There has been little exploration of this situation.

What influences attitudes towards clinically assisted hydration in the care of dying patients? A review of the literature

“…Further studies considered ANH in specific chronic disease populations, and in particular highlighted the ethical and legal judgements made during decision-making processes. In an Australian study, Van der Reit et al 26 describes ANH decision making for patients with severe brain injury, balancing quality of life versus prolongation of life. In a Dutch study27 of dementia patients cared for within nursing homes, the overall consensus of staff and families was that refusal to eat or drink in the advanced stages of the illness should be respected.…”

Artificial Nutrition and Hydration at the End of Life

“…Older adults should be informed about the risks and burdens of life prolongation through artificial means long before emergencies arise and EOL care is instituted (208). Practitioners must be well informed regarding the legal, ethical, clinical, religious, cultural, personal, and fiscal aspects of ANH in the dying older adult (209). Practitioners must be cognizant of their own biases and make sure that every person is evaluated individually so that a ''blanket'' approach is not taken (210).…”

Nutritional support and quality of life in cancer patients undergoing palliative care

“…Difficulty in eating and drinking often causes an anxiety in the patients' entourage, who worry that the patient will starve to death (Chiu et al 2002;Van der Riet et al 2009). Difficulty in eating and drinking often causes an anxiety in the patients' entourage, who worry that the patient will starve to death (Chiu et al 2002;Van der Riet et al 2009).…”

“…There is enough evidence to prove that palliative care delivered by specialist palliative care services is more effective than care delivered by nonspecialist teams (Maltoni & Amadori 2001;Morita et al 2006;Van der Riet et al 2009). There is enough evidence to prove that palliative care delivered by specialist palliative care services is more effective than care delivered by nonspecialist teams (Maltoni & Amadori 2001;Morita et al 2006;Van der Riet et al 2009).…”