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Withholding Artificial Nutrition and Hydration
Withholding artificial nutrition and hydration at the end of life may present difficult decisions for some patients and their families. Data demonstrates that these procedures have numerous associated risks at the end of life which are accompanied by pain and discomfort. Nonetheless, some families are still emotionally distressed at withholding artificial nutrition and hydration. Families counseled by trained staff can be educated about risks and outcomes as well as be reassured by these palliative medicine specialists. Whatever the family decides, staff working in long-term care must respect the decisions made by residents in advance directives or those of the family.
As more and more residents and their families indicate through advance medical directives the desire to withhold artificial nutrition and hydration in the final days of life, staff working in long term care must understand what their special role must now include. This DVD presents a discussion with nursing assistants and hospice staff led by Dr. Wertheimer addressing this new role. In the final days of life, the care provided by staff changes. The goal is now to make the patient as comfortable as possible. While patients do not complain of thirst, dry mouth is common. Ice chips, moist sponges, lip moisturizers, and frequent mouth care provide comfort to the resident. If there are any signs of pain, distress or agitation, they should be immediately reported so that medications can be adjusted. Nursing staff providing care during the final days of life express their rewards and talk about finding time just to sit by a bedside, holding a resident's hand, or just talking softly to the patient, letting both patients and families know someone is there with them.