What is the role of clinically assisted hydration in the last days of life?

Davies, Andrew; Barry, Caroline; Barclay, Stephen

doi:10.1136/bmj-2022-072116

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…The studies included in these reviews involved either intravenous or subcutaneous administration of fluids; no study involved the enteral route. Currently, one large randomized controlled trial is underway to determine whether intravenous or subcutaneous fluids in the last week of life prevents delirium 29 …”

Section: Discretionmentioning

confidence: 99%

Drugs, delirium, and ethics at the end of life

Thomas,

Alici,

Breitbart

et al. 2024

J American Geriatrics Society

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For older persons with delirium at the end of life, treatment involves complex trade‐offs and highly value‐sensitive decisions. The principles of beneficence, nonmaleficence, respect for autonomy, and justice establish important parameters but lack the structure necessary to guide clinicians in the optimal management of these patients. We propose a set of ethical rules to guide therapeutics—the canons of therapy—as a toolset to help clinicians deliberate about the competing concerns involved in the management of older patients with delirium at the end of life. These canons are standards of judgment that reflect how many experienced clinicians already intuitively practice, but which are helpful to articulate and apply as basic building blocks for a relatively neglected but emerging ethics of therapy. The canons of therapy most pertinent to the care of patients with delirium at the end of life are as follows: (1) restoration, which counsels that the goal of all treatment is to restore the patient, as much as possible, to homeostatic equilibrium; (2) means‐end proportionality, which holds that every treatment should be well‐fitted to the intended goal or end; (3) discretion, which counsels that an awareness of the limits of medical knowledge and practice should guide all treatment decisions; and (4) parsimony, which maintains that only as much therapeutic force as is necessary should be used to achieve the therapeutic goal. Carefully weighed and applied, these canons of therapy may provide the ethical structure needed to help clinicians optimally navigate complex cases.

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Section: Discretionmentioning

confidence: 99%

Drugs, delirium, and ethics at the end of life

Thomas,

Alici,

Breitbart

et al. 2024

J American Geriatrics Society

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“…We provide palliative care for patients in their last days—often patients we know well. I welcomed this article covering the uncertainties around harm and benefit for clinically assisted hydration 1…”

mentioning

confidence: 99%

Hydration in the last days of life: can we talk about the harms of repeated cannulation?

Dawson¹

2023

BMJ

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“…Dawson raises a question about the harms of repeated intravenous cannulation 1. As stated in our introduction,2 however, clinically assisted hydration is not synonymous with intravenous administration and, especially at the end of life, the subcutaneous route is often used in preference to the intravenous route (if a parenteral route is used). The latter is especially relevant for non-secondary care settings, such as hospice or home settings.…”

mentioning

confidence: 99%