[Ethical implications in the therapeutic management of dehydrated patients at the end of life]. / Ethische Implikationen bei der Therapie von dehydrierten Patienten am Lebensende.

ABSTRACT

BACKGROUND: The ethical framework for fluid management in the palliative care setting can vary. OBJECTIVES: What are the relevant ethical implications related to dehydration during end-of-life care and what are the special requirements we need to consider as far as "terminal dehydration" is concerned? MATERIALS AND METHODS: A comprehensive literature search was conducted to identify relevant articles published in English and German. RESULTS: Our inferences represent an attitude rather than an evidence-based position-a fact that is due to the underlying normative and ethical references which are hardly amenable to statistical evaluation. As far as ethical considerations are concerned, evidence is lacking to support clear decision-making and, thus, does not justify moving away from established concepts of clinically assisted hydration (CAH) at the end of life as long as measures can be effectually implemented. CONCLUSIONS: Dehydration must not be considered a measure to hasten death. Hence, dehydration in the palliative care setting must be regarded a "symptom" that should be "controlled" if it can be corrected by therapeutic means and if the patient's will does not contradict that approach. However, if CAH is futile, it is justified to refuse or stop it.