Research question: In terminally ill patients with 24-48 hours of life expected, is there any harm in receiving artificial hydration?
Wu, C. Y., Chen, P. J., Ho, T. L., Lin, W. Y., & Cheng, S. Y. (2021). To hydrate or not to hydrate? The effect of hydration on survival, symptoms and quality of dying among terminally ill cancer patients. BMC Palliative Care, 20(1), 13. Web.
Artificial hydration (AH) for terminal patients is a source of fluid acquisition and prevention of tissue dehydration. Wu et al. (2021) point out that AH can benefit at a rate of 400 ml per day. They have found no reliable effects of AH on survival and dehydration symptoms, although a literature review focuses on harmful effects (Wu et al., 2021). Conducting their study, they found that AH positively affected perceptions of one’s end of life. Patients reported decreased anxiety and worry, and their families spent more time with them. Wu et al. (2021) believe that AH will improve the quality of dying and provide psychological comfort for dying patients while there will be no detectable significant abnormalities of the terminal state. The integration of AH will help patients prepare for the end of life.
The study’s validity is confirmed by an extensive sample (100 people) who participated. Wu et al. (2021) indicate cooperation with an ethics committee, confirming the comprehensiveness of the problem studied and proving its relevance over the decades as new information becomes available. They fulfill the condition about the relevance of the findings and their scope. They conclude with their recommendations on AH norms for terminal patients.
Lokker, M. E., van der Heide, A., Oldenmenger, W. H., van der Rijt, C. C. D., & van Zuylen, L. (2021). Hydration and symptoms in the last days of life. BMJ Supportive & Palliative Care, 11(3), 335–343. Web.
The provision of fluids for patients in the terminal stage is a matter of quality of dying and minimization of stresses on the patient’s condition. Lokker et al. (2021) analyzed the terminal anxiety in the last 48-25 hours of life, arising from the near end of life, which undermines the psychological state of patients. Finding it in 26% of patients, Lokker et al. (2021) determined that fluid levels did not affect the degree of anxiety expressed over several days but did affect the last 48-25 hours. They concluded that high fluid intake increases anxiety, so hydration is not only a useless intervention but a harmful one. The results obtained point to the unethicality of hydration in the last hours because it violates the autonomy and comfort of the end of life.
The publication in a peer-reviewed journal and the full compliance of the work with the principles of ethics confirm the study’s validity. The results have a high level of evidence and connection with previous studies, confirming the problem’s relevance and the complexity of its solution. It should be considered that the authors lay down an idea for future research and suggest limitations and strengths, thereby honestly evaluating their results.
Wu, C. Y., Chen, P. J., Cheng, S. Y., Suh, S. Y., Huang, H. L., Lin, W. Y., Hiratsuka, Y., Kim, S. H., Yamaguchi, T., Morita, T., Tsuneto, S., Mori, M., & EASED Investigators (2022). Association between the amount of artificial hydration and quality of dying among terminally ill patients with cancer: The East Asian collaborative cross-cultural study to elucidate the dying process. Cancer, 128(8), 1699–1708. Web.
The study of the psychological comfort of dying and the quality of dying is one of the goals of determining how to improve conditions for terminally ill patients. AH can be a source of solutions to shortness of breath that accompany the end of life. Wu et al. (2022) focused their study on assessing the amount of AH, finding that volumes of 250 to 499 mL improve the quality of dying. Although the differences between fluid volumes showed no significant difference, the authors found significant differences between the absences of AH. Wu et al. (2022) believe that their results will allow the introduction of AH as a tool to alleviate the symptoms that accompany the last hours of patients’ lives. Consequently, AH does not cause harm but rather allows for relieving the dying process.
The study’s validity is confirmed by its affiliation with the American Cancer Society, which directly sponsors the work. The study is randomized, and the results are statistically tested. The study meets the requirements for the validity of the data obtained, as well as the ethical conditions for such work. The authors have sufficient expertise in the field of research, and several authorities have reviewed the results.
Barrado-Martín, Y., Hatter, L., Moore, K. J., Sampson, E. L., Rait, G., Manthorpe, J., Smith, C. H., Nair, P., & Davies, N. (2021). Nutrition and hydration for people living with dementia near the end of life: A qualitative systematic review. Journal of Advanced Nursing, 77(2), 664–680. Web.
At the end of life, a different place is occupied by the ethics of care, which can serve as a moral reminder of near death. Barrado-Martín et al. (2021) point out that the use of AH is a question of the comfort in dying. They focus on the subtle issue of individuals with dementia who may not represent their own needs. Barrado-Martín et al. (2021) note that a deeply interdisciplinary approach is required to ensure a comfortable dying in which some of the negative effects of hydration will not exacerbate patients’ state. Limited planning is the problem that prevents the creation of conditions for the actual benefits of AH. Patients with dementia cannot plan their care in this perspective (the last 48-24 hours of life), so this responsibility falls on the physicians.
The authors are competent enough to argue about hydration and nutritional planning difficulties at the end of life. The study is supported by evidences and a multi-year sample of papers to study. Barrado-Martín et al.’s (2021) recommendations are relevant and applicable to the topic of the study because they combine an interdisciplinary approach. The conclusions can be taken as substantive and integrated into future work in the field.
Baillie, J., Anagnostou, D., Sivell, S., Van Godwin, J., Byrne, A., & Nelson, A. (2018). Symptom management, nutrition and hydration at end-of-life: A qualitative exploration of patients’, carers’ and health professionals’ experiences and further research questions. BMC palliative care, 17(1), 60. Web.
Perceptions of end-of-life care raise questions of ethics and empathy on the part of worried patients and staff. Baillie et al. (2018) point out that the general perception of AH among medical staff is rather negative. Staff indicates that they consistently lack evidence and practice to determine the value of hydration at the end of life, and decisions are based on past singular experiences. There are limitations in accurately interpreting whether effects result from AH. Baillie et al. (2018) found low levels of positive perceptions of hydration by staff concerned about outcomes such as shortness of breath, death rattle, and tissue swelling. Such findings point to an ongoing suspension of questions about the value of hydration as an end-of-life support.
The level of evidence is not high enough to understand the problem. However, it points to the problem of AH use in practice and is, therefore, valuable for understanding the scope and relevance of the problem. In addition, the literature used in the article is quite extensive, allowing some parts of the paper to be used to draw conclusions and predict the study’s results. The conclusions obtained are also worth considering relevant because of the publication in a peer-reviewed journal.