TY - JOUR T1 - On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A reply. JF - Journal of Medical Ethics JO - J Med Ethics SP - 141 LP - 143 DO - 10.1136/jme.21.3.141 VL - 21 IS - 3 AU - R J Dunlop AU - J E Ellershaw AU - M J Baines AU - N Sykes AU - C M Saunders Y1 - 1995/06/01 UR - http://jme.bmj.com/content/21/3/141.abstract N2 - Patients who are dying of cancer usually give up eating and then stop drinking. This raises ethical dilemmas about providing nutritional support and fluid replacement. The decision-making process should be based on a knowledge of the risks and benefits of giving or withholding treatments. There is no clear evidence that increased nutritional support or fluid therapy alters comfort, mental status or survival of patients who are dying. Rarely, subcutaneous fluid administration in the dying patient may be justified if the family remain distressed despite due consideration of the lack of medical benefit versus the risks. Some cancer patients who are not imminently dying become dehydrated from reversible conditions such as hypercalcaemia. This may mimic the effects of advanced cancer. These conditions should be sought and fluid replacement therapy should be given along with the specific treatments for the condition. ER -