Abstract
Objectives: To determine the role and influence of participants in the decision making to start or forgo artificial nutrition and hydration (ANH) in demented nursing home patients. Methods: Participant observation by two researchers in two Dutch nursing homes. Results: The most common participants in the ANH decision making are the nursing home physician (NHP), family, and (most frequently attending) nurses. Both the process and outcome depend on the specific orientation of participants to the decision-making process, to starting or forgoing ANH and interactions between participants. The NHP has the greatest influence. Most NHPs try to achieve consensus among all participants, and emotions and feelings of the family play an important role in this respect. Discussion: The NHP seems to be the most obvious person to lead the ANH decision. It is important that participants are aware of the influence of emotions so that they can determine to what extent it is acceptable that personal feelings influence the final decision.
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