[Dysphagia] Withholding AHN :position statement of AAHPM

[eripley at yahoo.com (Irene Campbell-Taylor)]

AAHPM Position Statement on AHN

To provide clarity on the use of artificial hydration and nutrition, the

American Academy of Hospice and Palliative Medicine offers the following

position statement:

The American Academy of Hospice and Palliative Medicine recognizes dying as

an expected natural process in the human life cycle. AAHPM supports excellence

in end-of-life care with attention to relief of physical, psychological, spiritual,

and social distress in the dying process for patients and their families.

Hydration and nutrition are traditionally considered useful and necessary components

of good medical care. They are provided with the primary intention of

benefiting the patient. However, when a person is approaching death, the provision

of artificial hydration and nutrition is potentially harmful and may provide

little or no benefit to the patient and at times may make the period of dying

more uncomfortable for both patient and family. For this reason, the AAHPM

believes that the withholding of artificial hydration and nutrition near the end

of life may be appropriate and beneficial medical care. Clinical judgment and

skill in assessment of individual clinical situations is necessary to determine

when artificial hydration and nutrition are appropriate measures to apply.

 

The complete article is available at:
http://www.aahpm.org/education/arthy.pdf
See also:

Discomfort in nursing home patients with severe dementia in whom artificial nutrition and hydration is forgone. Arch Intern Med. 2005 Aug 8-22;165(15):1729-35.

Pasman HR, Onwuteaka-Philipsen BD, Kriegsman DM, Ooms ME, Ribbe MW, van der Wal G.

BACKGROUND: While there is debate about whether it may be better to forgo than to initiate artificial nutrition and hydration (ANH) in nursing home patients with severe dementia, the consequences of forgoing ANH in these patients, in particular their discomfort, have not yet been investigated. METHODS: In this prospective, longitudinal, observational study of 178 patients in nursing homes, discomfort was measured at all measurement times according to the observational Discomfort Scale-Dementia of Alzheimer Type. Furthermore, at all measurement times, plausible determinants of discomfort were registered. Data were analyzed with the statistical technique of generalized estimated equations. RESULTS: Decisions to forgo ANH were made most often in severely demented, female patients with an acute illness as the most important diagnosis at that time. The mean level of discomfort was highest at the time of the decision and decreased in the days thereafter. There were substantial differences
 in level of discomfort between patients. Dyspnea, restlessness, and physicians' observations of pain and dehydration were associated with higher levels of discomfort. Furthermore, patients who were awake had higher levels of observed discomfort than patients who were asleep. CONCLUSIONS: Forgoing ANH in patients with severe dementia who scarcely or no longer eat or drink seems, in general, not to be associated with high levels of discomfort. The individual differences emphasize the need for constant attention for possible discomfort.

 



Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com