Nurses' attitudes towards artificial food or fluid administration in patients with dementia and in terminally ill patients: a review of the literature.
OBJECTIVE
Although nurses have an important role in the care process surrounding artificial food or fluid administration in patients with dementia or in terminally ill patients, little is known about their attitudes towards this issue. The purpose of this study was to thoroughly examine nurses' attitudes by means of a literature review.


METHODS
An extensive systematic search of the electronic databases PubMed, Cinahl, PsycINFO, The Cochrane Library, FRANCIS, Philosopher's Index and Social Sciences Citation Index was conducted to identify pertinent articles published from January 1990 to January 2007.


RESULTS
Nurses' arguments for or against could be categorised as ethical-legal, clinical or social-professional. The most important arguments explicitly for artificial food and fluid administration in patients with dementia or in terminally ill patients were sanctity of life, considering artificial food and fluid administration as basic nursing care, and giving reliable nutrition, hydration or medication. An explicit counter-argument was the high cost of treatment. Arguments used by opponents and proponents were quality of life and dignified death. The arguments were not strikingly different for the two patient populations. It turned out that the nurses' ethical arguments remarkably reflected the current ethical debate. But some of their clinical presuppositions contradicted current clinical evidence.


CONCLUSIONS
The interaction between clinical facts and ethical reflections makes the findings of this review extremely relevant for clinical ethics. A large need exists to clearly communicate to nurses the latest clinical evidence and the main results of ongoing ethical debates.
Bryon
E
E
Center for Biomedical Ethics and Law, Catholic University of Leuven, Kapucijnenvoer 35/3, B-3000 Leuven, Belgium. els.bryon@med.kuleuven.be
de Casterlé
B Dierckx
BD
Gastmans
C
C
D001291:Attitude of Health Personnel; D003657:Decision Making / Q000941:ethics; D003704:Dementia / Q000628:therapy; D004993:Ethics, Nursing; D006801:Humans; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology*; D018529:Nutritional Support / Q000009:adverse effects / Q000941:ethics*; D011788:Quality of Life; D013727:Terminal Care / Q000941:ethics*; D019452:Terminally Ill; D028761:Withholding Treatment / Q000941:ethics