Article

In the majority of cases, severe stroke is accompanied by difficulty in
swallowing and an altered state of consciousness requiring artificial nutrition
and hydration. Because of their artificial nature, nutrition and hydration are
considered by law as treatment rather basic care. Withdrawal of these treatments
is dictated by the refusal of unreasonable obstinacy enshrined in law and is
justified by the risk of severe disability and very poor quality of life. It is
usually the last among other withholding and withdrawal decisions which have
already been made during the long course of the disease. Reaching a collegial
consensus on a controversial decision such as artificial nutrition and hydration
withdrawal is a difficult and complex process. The reluctance for such decisions
is mainly due to the symbolic value of food and hydration, to the fear of "dying
badly" while suffering from hunger and thirst, and to the difficult distinction
between this medical act and euthanasia. The only way to overcome such reluctance
is to ensure flawless accompaniment, associating sedation and appropriate comfort
care with a clear explanation (with relatives but also caregivers) of the
rationale and implications of this type of decision. All teams dealing with this
type of situation must have thoroughly thought through the medical, legal and
ethical considerations involved in making this difficult decision.
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Langue : FRANCAIS