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ss triple helix - winter 2007,  No Water – No Life - Hydration in the Dying (Book Review)

No Water – No Life - Hydration in the Dying (Book Review)

No Water – No Life - Hydration in the Dying - Gillian Craig (ed) Fairway Folio 2004 - £15 Pb 188pp - ISBN 0 95454 4536

The debate about hydration in the dying has been intense and very important. Gillian Craig, a retired geriatrician, brings an excellent breath of fresh air to this debate, providing data, published research and a wide range of opinion. The style of the book is interesting, a collage of papers and opinion. In one book she provides access to a lot of papers and opinions, along with just a few bits of her own commentary.

Hydration is essential for life but a view has arisen that those who are dying do not suffer from thirst. Developed in the context of cancer care, this view has been extrapolated to those who have fluid and food removed following strokes and other illnesses. Under English and Welsh Law, artificial nutrition and hydration are viewed as medical treatments. As such, BMA guidance permits their removal with the result that patients who have suffered a stroke or other illness may die from dehydration. Craig's book scrutinizes this practice and the clinical evidence and moral theories that are used to support it.

Craig has worked hard to review the broad body of evidence on this subject, to challenge current medical wisdom, and to put it into context. Having read her work, I am drawn to the conclusion that the evidence has often been selected and extrapolated to fit with the desire to believe that removing food and fluid is okay. This is most certainly Craig's view. She has done a huge service in putting the evidence into a single, readable place.

The book outlines the way in which medical opinion has changed in recent years. Dame Cicely Saunders supported the use of subcutaneous fluids and I well remember using them when I first qualified. I still find that patients and relatives consider it to help at times. But my overriding impression is that there is now a widespread fear of starting fluids and a perceived wisdom that doing so does not reduce suffering.

I recommend this book as an excellent reference and summary of this crucial debate; it is relevant to all who care for frail dying people.

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