Dehydration in dying patients: study with physicians in French-speaking Switzerland

We surveyed physicians in French-speaking Switzerland to assess the perception of suffering resulting from dehydration and its relation to the clinical choice between oral and artificial hydration. A questionnaire describing hypothetical cases of dehydration in an elderly terminal cancer patient in different clinical situations (conscious, demented, comatose) was sent to 978 physicians. The physicians were asked to assess the discomfort due to dehydration and the treatment they would propose in order to correct this situation (oral or artificial hydration). The return rate was 41%. The results show that there is no consensus with respect to the assessment of suffering (it gets a "low" score from 33% of replies and a "high" score from 41% of replies) or of thirst ("low": 30%, "high": 43%). Only 28% of the replies indicated artificial hydration for conscious patients while 44% chose this treatment for comatose patients. Physicians choosing artificial hydration were significantly more prone to consider suffering and thirst as "serious" than those preferring hydration by mouth. It can be concluded that two thirds of the physicians who responded think that artificial hydration is not the best way to respond to dehydration in dying patients. The choice depends partly on the assessment of the suffering and thirst resulting from terminal dehydration.