Is terminal dehydration painful? No. Terminal dehydration is not painful as a rule, especially when good comfort care measures and undertaken. |
According to one recent study of hospice nurses in Oregon conducted by Ganzini and her associates, nurses reported that patients experienced relative good deaths after deciding to stop eating and drinking. On a scale that ranged from 0 (a very bad death) to 9 (a very good death) the median score for "quality of the death" was 8 (as rated by nurses who cared for the patients who chose to forgo food and fluids at the end of life). |
Physical comfort Terminal dehydration may be responsible for increasing the comfort level of the dying process, for a number of reasons listed below. Se also "Potential benefits of not using tube feedings and IV’s" from Handbook for Mortals: Guidance for People Facing Serious Illness, Joanne Lynn (MD) and Joan Harrold (MD) [2001].
- Dehydration has an analgesic effect in some patients, leading them to request less medication to control pain than they usually need. Part of the decrease in pain can be attributed to the reduction of swelling in patients who have tumors.
- Dehydration leads to a more general decrease in sensation levels as time progresses.
- Patients who forgo artificially provided nutrition and hydration eliminate the irritation associated with the feeding tubes. This irritation is not only physical, but mental as well: Eliminating tube feeding decreases the trapped, agitated feelings that require many tube fed patients to be physically restrained.
- Patients who forgo artificially provided nutrition and hydration suffer less from congestion, coughing, choking and the "drowning" sensation that often accompanies tube feeding. The possibility of developing aspiration pneumonia also decreases with cessation of tube feeding.
- Patients who forgo artificially provided nutrition and hydration are less likely to vomit.
- Decreased urine output in patients who forgo artificially provided nutrition leads to the decrease or elimination of urinary related sources of pain and discomfort (bed wetting accidents, the need for bed pans, diaper changes, and trips to commode, and the incidence of urinary tract infection all decrease with the elimination of fluid intake).
Social benefits: There are also a number of "social benefits" that come with the forgoing of artificially provided nutrition and hydration. Most importantly, the elimination of technological barriers makes it easier for family members to provide comfort care and be there with their loved one at time of death.
Citations
Ahronheim, Judith C., and Gasner, M. R. 1990. "The Sloganism of Starvation." The Lancet. Vol. 335, pp. 278-279.
Andrews, Maria R., and Levine, Alan M. 1989. "Dehydration in the Terminal Patient: Perception of Hospice Nurses," The American Journal of Hospice Care. January/February, pp. 31-34.
Ganzini, Linda, et al. 2003. "Nurses' Experiences with Hospice Patients Who Refuse Food and Fluids to Hasten Death," New England Journal of Medicine. Vol 349;4. pp. 359-365.
Lynn, Joanne, and Harrold, Joan. 2001. Handbook for Mortals: Guidance for People Facing Serious Illness. New York: Oxford University Press, pp. 129-138.
Post, Stephen G. 1990. "Nutrition, Hydration, and the Demented Elderly." The Journal of Medical Humanities. Vol. 11, pp. 185-192.
Printz, Louise A. 1988. "Is Withholding Hydration a Valid Comfort Measure in the Terminally Ill?" Geriatrics. Vol. 43, pp. 84-88.
Schmitz, Phyllis, and O’Brien, Merry. 1989. "Observation on Nutrition and Hydration in Dying Cancer Patients." In Joanne Lynn, ed., By No Extraordinary Means: The Choice to Forgo Life-Sustaining Food and Water. Bloomington, Ind.: University Press, pp. 29-38.
Sullivan, Robert J. 1993. "Accepting Death without Artificial Nutrition andHydration," Journal of General Internal Medicine. Vol. 8, pp. 220-224.
Sutcliffe, Jayne. 1994. "Palliative care: Terminal dehydration," Nursing Times, Vol. 90, pp. 60-3.
