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May 1983

Are Intravenous Fluids Morally Required for a Dying Patient?

Author Affiliations

From the Oncology Service (Drs Micetich and Steinecker), and the Medical Humanities Program (Dr Thomasma), Loyola University Stritch School of Medicine, Maywood, Ill.

Arch Intern Med. 1983;143(5):975-978. doi:10.1001/archinte.1983.00350050135024

The distinction between ordinary and extraordinary obligations to dying patients has been in existence for more than 30 years.1 Most thinkers in medical ethics have abandoned the distinction.2 However, we found that clinicians invariably used this distinction. For example, clinicians consider intravenous (IV) fluids ordinary and standard measures, as opposed to extraordinary, heroic, resuscitative measures. Normally, IV fluids are regarded as morally required for dying patients because, at a minimum, they provide water and calories to sustain life for a short period.

Given the extent of modern medical technology, the ethical problems of keeping dying patients alive have been magnified. Recently, for example, two physicians in California have been indicted for murder for withdrawing IV fluids and nasogastric feedings from a dying, comatose patient.3 A search of the ethical literature disclosed only one article on the problem of withdrawing IV fluids.4 Traditionally, IV fluids are not

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