- Making decisions about nutrition and hydration is complex and we need to understand the complexity
- Receiving nutrition and hydration may be life sustaining but we can then be at risk of prolonging a very poor quality of life
- We need to listen carefully to appreciate the perspectives of the people involved. These may be due to personal values, interpretation of information or emotional reactions. Risk versus benefit for any decisions should be clearly documented.
- Rushed or ill-informed discussions can have a lasting impact
- We need to document what we have discussed, what we are doing and explain decisions to allow the multi-disciplinary team to provide a consistent approach
- Decisions will be on a case by case basis taking full account of the person’s and family’s wishes but within both legal and best practice guidelines
- Offering oral intake for comfort at the end of life is considered basic care and when a person is unable to take anything orally, ensuring they receive adequate oral care is paramount. Treatment approaches can change quickly and when a person transitions from active treatment with alternative nutrition e.g. Nasogastric Tube under a “Nil By Mouth” recommendation due to unsafe swallow, to a palliative treatment approach, where alternative nutrition is removed, their ability to accept some oral intake for comfort should be reviewed promptly.
- Families may require psychosocial support and an understanding of why appetite diminishes and why oral intake may change towards end of life. While swallowing difficulties can have a significant impact, other factors such as change in taste, loss of smell, loss of appetite, change in bowels, nausea can all impact (RCP, 2021)
- When a person has capacity, or has previously stated their wishes regarding eating and drinking, or a best interest decision regarding eating and drinking has been made, and a decision is made that may seem unwise to others e.g. eating and drinking with acknowledged risk, as long as their carers who act upon their request have acted with due care, they should not be exposed to any liability if the person, does, in fact, suffer adverse consequences. (RCP, 2021).
Well done, you have reached the end of this section. What do you want to do next?
Page last reviewed: 16 Jan 2023
