How can speech and language therapists help decision-making on clinically assisted hydration for adults at the end of life?

While reducing oral intake is a natural occurrence when a person is dying, there may be situations where the healthcare team need to decide whether to withhold, initiate, continue or withdraw clinically assisted hydration (CAH), in discussion with the dying person and significant others. Speech and language therapists (SLTs) are increasingly part of the healthcare team, managing a person’s dysphagia and communication when they are nearing the end of their life. An SLT can assist with differentiating between clinical symptoms, help determine whether oral fluid intake is as comfortable as possible, enhance oral hygiene, ensure a person can make informed choices around their hydration, and support the person and those close to them to understand the healthcare team’s decision-making. The SLT’s specialist knowledge and skills can enhance the multidisciplinary team’s care quality. This article aims to provide an overview of the clinical and ethical considerations of CAH in adults, relevant to the field of SLT, alongside the SLT role. Given there is no clinical consensus on the benefits and risks of CAH in the last week of life, healthcare teams need to take a person-centred approach when considering the options around CAH. Oral fluid intake, where possible, should be encouraged. Respect for a person’s autonomy, alongside effective communication, ensures that a competent individual can decide whether to accept CAH if offered.