When the intervention causes complications (e.g., agitation requiring sedation or physical restraints, infection, multiple tube obstructions or withdrawal, aspiration pneumonia) When a patient has moderate or severe, irreversible cognitive impairment (e.g., Alzheimer's dementia or vascular dementia) When the patient is dying, and the intervention is merely prolonging the dying process or causing suffering When the intervention is bound to fail (e.g., in patients with a disease that is uniformly fatal) When the primary goal of the patient is palliation of symptoms The patient or decision maker, after being provided appropriate counseling and options, decides against this intervention to reflect personal values. Potential reasons to withhold or withdraw artificial hydration or nutrition When the quality of life is good, as defined by the patient When there is no clear decision maker, and the family cannot reach a consensus To maintain life for a period, while the decision maker/family struggles with end-of-life decisions When a patient is unable to swallow and remains hungry or thirsty In selected chronic conditions (e.g., patients with esophageal obstruction or massive bowel resection, where oral intake is not possible or inadequate) In this case, consider a trial of the intervention with withdrawal if little or no benefit accruesĪs short-term interventions in healthy patients or those with mild or moderately severe illness (e.g., acute infections, perioperative use, acute stroke) When the risk/benefit ratio is unclear, or the evolution of the disease is uncertain. When the patient is stable or improving, and the intervention has a reasonable chance of reaching the patient's goals When the primary goal of the patient is to maximize the quantity of life The patient or decision maker, after being provided appropriate counseling and options, chooses this intervention to reflect personal values. Indications to consider starting artificial hydration or nutrition
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