Caroline Barry

Caroline Barry turned to holistic medicine when their doctors kept misgendering them during appointments.

### What you need to knowClinically assisted hydration, also known as medically assisted hydration, is the process by which “fluids” are given parenterally via a cannula (either intravenously or subcutaneously) or enterally via a tube (into the stomach or small bowel or, less commonly, into the rectum). Decisions about the role of clinically assisted hydration in the last days of life are often complex and can have a major impact on the dying patient, as well as their loved ones and clinical staff. These challenging clinical decisions must be made with high degrees of uncertainty due to a paucity of evidence. This article summarises the evidence base for clinically assisted hydration in the last days of life and offers suggestions for clinical practice in light of these uncertainties.Possible benefits and harms of clinically assisted hydration in the last days of life are varied. Proposed benefits include patient comfort (such as prevention of thirst and dry mouth) and the maintenance of renal perfusion with prevention of accumulation of toxins and drugs (prevention of delirium and opioid toxicity).1 Delirium is a common problem at the end of life and is the cause of much distress to patients, their loved ones, and clinical staff. Possible harms of hydration include fluid overload (such as worsening of peripheral oedema and cardiac failure), fluid related complications (such as worsening of vomiting and respiratory secretions),1 and medicalisation of the normal dying process. Some commentators even …

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