To feed or not to feed? Clinical aspects of withholding and withdrawing food and fluids at the end of life

The issue of withholding and withdrawing clinically assisted nutrition and hydration (CANH) for imminently dying patients is very contentious. There is no agreement between medical professionals and problem of forgoing CANH is subject of a fierce and sometimes emotional debate. This paper makes an attempt to examine briefly current clinical evidence on withdrawing and withholding CANH at the end of life. It tries to assess whether it is always beneficial for a patient to provide CANH or whether providing CANH may sometimes cause more harm than good. It also addresses a question whether forgoing CANH for some imminently dying patients is consistent with fundamentals of palliative care. For this reason withholding or withdrawing CANH will be analysed in a context of basic assumptions of palliative care which are presented in the World Health Organisation’s definition of this distinctive branch of medicine. Adv. Pall. Med. 2011; 10, 1: 3–10The issue of withholding and withdrawing clinically assisted nutrition and hydration (CANH) for imminently dying patients is very contentious. There is no agreement between medical professionals and problem of forgoing CANH is subject of a fierce and sometimes emotional debate. This paper makes an attempt to examine briefly current clinical evidence on withdrawing and withholding CANH at the end of life. It tries to assess whether it is always beneficial for a patient to provide CANH or whether providing CANH may sometimes cause more harm than good. It also addresses a question whether forgoing CANH for some imminently dying patients is consistent with fundamentals of palliative care. For this reason withholding or withdrawing CANH will be analysed in a context of basic assumptions of palliative care which are presented in the World Health Organisation’s definition of this distinctive branch of medicine. Adv. Pall. Med. 2011; 10, 1: 3–1