BMA guidance

Clinically-assisted nutrition and hydration

This guidance provides detailed practical advice on the issues you might encounter when making a decision to stop, start, or continue CANH for adults who lack capacity.
Location: England Wales
Audience: All doctors
Updated: Tuesday 11 February 2020
Justice scales article illustration

The guidance is split into two parts:

  • general guidance which applies in all cases (part one)
  • specific guidance for the different categories of patients covered by the guidance (part two).

You are advised to read the whole of part one and the relevant section(s) of part two.

What you'll get from this guide

  • An up-to-date statement of your legal and professional obligations in relation to decisions about CANH (clinically-assisted nutrition and hydration).
  • A step-by-step guide to the decision-making process to be followed.
  • Detailed practical guidance on approaching best interests assessments.

 

How to use this guide

Decisions about whether to start, continue, or stop clinically-assisted nutrition and hydration (CANH) are made on a daily basis across England and Wales – but few decisions are more challenging for healthcare professionals.

Although there is a very strong presumption that it will be in a person’s best interests to prolong life, for some patients CANH will not be in their best interests, because it is not able to provide a quality of life they would find acceptable – and in these circumstances, legally and ethically, it should not be provided. This guidance sets out how these decisions should be made, in a wide range of clinical scenarios.

This guidance does not provide a simple set of instructions or define rules which must be followed without reflection, but is a tool to inform and aid decision-making. It does not provide easy answers, but offers an approach through which you can reach the appropriate decision.

Endorsements

The following organisations were involved in the development of the guidance and have provided formal endorsement.

  • The Nursing & Midwifery Council
  • British Geriatrics Society
  • Royal College of Occupational Therapists
  • Royal College of Nursing
  • General Medical Council
  • British Dietitians Association
  • Independent Neurorehabilitation Providers Alliance
  • The Faculty of Intensive Care Medicine
  • Royal College of General Practitioners
  • Intensive Care Society