Physiopathologie et sémiologie de l'arrêt de nutrition et d'hydratation

One of the most controversial decisions in the end-of-life situation is the withdrawal of nutrition and hydration because of concerns about the intention (provoke death) and the impact (malnutrition, dehydration) and their representations. We recall here the pathophysiological mechanisms involved and the clinical manifestations observed after withdrawal of nutrition and hydration. Paradoxically, the patient's suffering does not appear to be the primary concern but rather the moral suffering of the family. This element should always be noted before considering withdrawal. Two other elements are also noteworthy: continuing oral nutrition at a minimal rate is deleterious, as is the prescription of opioids, because of the toxic effects in the event of kidney failure.