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June 14, 1995

Nutrition and Hydration for the Terminally III

Author Affiliations

Royal Alexandra Hospital Edmonton, Alberta

JAMA. 1995;273(22):1736. doi:10.1001/jama.1995.03520460018013

To the Editor.  —The report by Dr McCann and colleagues1 on the clinical significance of artificial nutrition and fluids in terminally ill patients perpetuates the mistakes of previous reports that have placed the two issues on an equal footing.The authors correctly refer to articles that have failed to demonstrate a benefit of nutritional support in patients with advanced cancer, but in the same sentence include hydration, which was not studied in those reports.The controversy over the value of hydration in terminally ill patients is rooted in the traditional hospital approach of treating everyone with intravenous fluids until they die. The hospice philosophy is that, as the former approach is seen to cause many problems for the terminally ill, giving no fluids at all would be the correct solution.2 Both viewpoints are based on tradition and anecdotal reports, with conflicting case reports in the literature demonstrating the

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