IV hydration in the terminally ill: ritual or therapy?

The capacity to prolong life and to ease the plight of dying patients has improved to the extent that almost all acutely ill and seriously ill patients are hospitalized. As a consequence, most deaths now occur in institutions (Bandeman and Bandeman, 1990). The issue of whether artificial nutrition and hydration should be considered medical treatments that can be terminated, or basic elements of care that cannot be withheld, has been controversial and frequently adjudicated before state courts and the subject of legislation, particularly in the USA (Emanuel, 1992). While cases such as Anthony Bland in the UK and Nancy Cruzan in the USA have highlighted the problems surrounding patients who are not terminally ill, there is a paucity of research literature and guidelines on the ever-increasing problem of intravenous (IV) hydration in the terminally ill.