BMJ 2003;326:713 ( 29 March )

Letters

Artificially giving nutrition and fluids is not one action

The first 150 words of the full text of this article appear below.

EDITOR---The and colleagues' description of decision making for patients with severe dementia who have difficulties in eating and drinking, raises several troubling issues.1

Firstly, they implicitly consider tube feeding to be life sustaining. In fact, no credible data show that tube feeding prolongs life in advanced dementia.2-5 An honest summary of the data is, "We have no good evidence that tube feeding will prolong life, and chances are good your loved one will die soon if we put in a tube." To offer, "We could put in a tube or you can let your loved one starve" is inaccurate and often hurtful.

Secondly, administering nutrition and fluids is treated as a single intervention, one all or nothing decision. Acute, self limited illnesses can stop fluid intake, causing death in days. Providing fluids can prolong life. Unlike dehydration, poor intake of nutrients rarely threatens life acutely, usually occurring in . . . [Full text of this article]
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Relevant Article

Withholding the artificial administration of fluids and food from elderly patients with dementia: ethnographic study
Anne-Mei The, Roeline Pasman, Bregje Onwuteaka-Philipsen, Miel Ribbe, and Gerrit van der Wal
BMJ 2002 325: 1326. [Abstract] [Full Text] [PDF]

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