Palliative care aims to relieve suffering in all stages of disease and is not limited to the end of life. Patients in palliative care range from fully functional (especially if newly diagnosed with an incurable illness) to extremely limited (particularly at the end of life). Palliative services, including setting patient-centered achievable goals for medical care and aggressive symptom management, should be routinely offered alongside curative and disease-modifying treatments for patients with serious illnesses.
Medically-assisted nutrition and hydration should be considered medical interventions rather than a basic provision of comfort. Promoting early discussions with the patient and family about the goals of care and treatment choices, including the expected benefits and burdens of artificial nutrition and hydration based upon the best available evidence, is ethically appropriate, respects family and patient autonomy, and facilitates informed decision making.
This topic will address the role of artificial nutrition and/or hydration specifically as it applies to patients in palliative care who are in the last days or weeks of life. The issues involving the cessation of hydration and/or nutrition are most relevant to patients at the end of life, where there is little evidence that nutrition or hydration offers any benefit.
The role of artificial nutrition in patients not at the end of life is discussed elsewhere. (See "The role of parenteral and enteral/oral nutritional support in patients with cancer" and "Nutrition support in critically ill patients: Parenteral nutrition".)
In addition, the ethical and legal issues surrounding withholding and withdrawing of other forms of medical treatment at the end of life are discussed elsewhere. (See "Ethical issues near the end of life" and "Legal aspects of end of life care", section on 'Withdrawal of medical care'.)