Intended for healthcare professionals


Backdoor euthanasia

BMJ 1999; 318 doi: (Published 22 May 1999) Cite this as: BMJ 1999;318:1415

Withholding food and fluids is justifiable only for terminally ill

  1. James Paul, Specialist registrar in palliative medicinea
  1. aKilburn, London NW6 7HH
  2. Bryning Day Hospital, Homerton Hospital, London E9 6SR

    EDITOR—Recent articles in the general1 and medical press2 on “backdoor euthanasia” illustrate the confusion that surrounds the subject. This is especially true for decisions to withdraw or withhold food and fluids from ill patients. Focusing on the issue of the intention behind such actions may help to achieve some clarity.

    Current research, although limited, suggests that the desire for food and drink lessens in terminally ill patients and that artificial hydration neither prolongs survival nor alleviates symptoms. 3 4 Furthermore, drips and nasogastric feeding tubes can cause unnecessary distress to patients and their relatives. In such cases the withholding of these treatments is entirely appropriate as the intention is to save the patient from a treatment that has no medical benefit.

    But what about those who are not in the terminal stages of …

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