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Artificial hydration and nutrition in advanced Alzheimer's disease: facilitating family decision-making


  • Sandra K Eggenberger PhD, RN,

  • Tommie P Nelms PhD, RN

Tommie P Nelms
Texas Woman's University College of Nursing PO Box 425498 Denton TX 76204-5498 USA
Telephone: 940 898 2433


Background.  As Alzheimer's disease progresses to its final stages of dementia and dysphagia, whereby patients can no longer swallow food and fluids, families suffer with difficult decisions regarding initiation of artificial hydration and nutrition.

Aims and objectives.  Through the use of a hypothetical family scenario, this theoretical article presents the ethical principals of beneficence and autonomy as a framework for use by nurses to hear and inform family decision-makers of the physiology of death in the advanced stages of Alzheimer's and examines the current literature related to benefits and burdens of artificial hydration and nutrition.

Conclusions.  While a beneficial consideration, ethical principles are critiqued for their inability to provide an absolute answer and relieve family suffering in this clinical situation.

Relevance to clinical practice.  A nurse-lead consensus building process is proposed to guide family decision-making regarding artificial hydration and nutrition with advanced Alzheimer's disease.