Withholding or withdrawing artificial administration of food and fluids in nursing-home patients.
BACKGROUND
withholding or withdrawing artificial administration of food and fluids, especially in incompetent patients, has been the subject of turbulent discussions. Insight into this practice may be useful in the debate, and also in the development of guidelines.


OBJECTIVE
to gain insight into the frequency and circumstances of forgoing artificial administration of food and fluids in nursing homes.


METHODS
we sent a written questionnaire to the nursing-home physicians of a stratified sample of 6060 people who died in the Netherlands in 1995, and interviewed a random sample of 74 nursing-home physicians.


METHODS
Dutch nursing homes.


METHODS
incidence of withholding or withdrawing artificial administration of food, patient characteristics and features of the decision-making process.


RESULTS
in 23% of deaths in nursing homes, artificial administration of food and fluids were foregone. In two-thirds of cases, life was shortened by 1 week at most. The decision was almost always discussed with competent patients. In the case of incompetent patients, the decision was almost always discussed with the patient's relatives. Frequently mentioned considerations in the decision were: the patient's (presumed) wish, low quality of life, no prospect of improvement and the desire not unnecessarily to prolong life.


CONCLUSIONS
artificial administration of food and fluids is one of the most frequently forgone treatments in nursing homes. In general, the physician involves the patient or the patient's relatives and the nursing staff in the decision-making. In most cases, the nursing-home physicians thought that the decision to forgo artificial administration of food and fluids improved the patient's quality of dying.
Onwuteaka-Philipsen
B D
BD
Institute for Research in Extramural Medicine, Department of General Practice, Nursing Home Medicine and Social Medicine, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. b.philipsen.emgo@med.vu.nl
Pasman
H R
HR
Kruit
A
A
van der Heide
A
A
Ribbe
M W
MW
van der Wal
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004750:Enteral Nutrition / Q000639:trends*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes / Q000639:trends*; D010819:Physician's Role / Q000523:psychology*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D028761:Withholding Treatment / Q000706:statistics & numerical data / Q000639:trends*