Unfortunately, the industry has used the fear of this "prolonging a painful death," and used it to promote the removal of hydration and nutrition from those also who are not dying from cancer or advanced organic brain disease like jacquej described, but simply "failure to thrive" and dementia and stroke patients.
Deliberate dehydration in these latter circumstances, despite what the palliative care industry says, is a very uncomfortable (indeed, "tortuous") process, the symptoms of which must be masked by morphone, sedatives, haldol, etc.
A friend of mine is a hospitalist in Harrisburg. He says 50% of the patients admitted to the Catholic hospital where he works with advanced dementia or severe stroke are dead within a week. He calls it "7 day euthanasia," because these patients are not terminal unless you withdraw hydration. They are placed in palliative or hospice care, their food and water is withdrawn, they are given morphine, and they are dead in 7 days.
That is euthanasia, and it is occurring on a large scale in this country and abroad.
It is going on in hospice care as well as palliative care.
Yes, there are incredible individuals and individual hospice and palliative care programs out there offering compassionate, truly ethical care. I know some of them personally. But that is not universally the case. Far from it.
It’s an interesting position. Until my experience with my father, I had not thought about the industry around dying. It is there, though, somewhat systematic and quite effective in achieving its primary goal.
I do not have experience with others and other types of disease that you have from which to draw. I can see where the same approach applied to other diseases could be exactly the wrong treatment, but again it appears to me to be such a personal decision if you are able to make it lucidly and conscientiously.
In addition, where is the family or friends in situations that you describe? Having an advocate who knows your wishes seems critical.
It seems medical technology has advanced to the point where difficult end-of-life decisions must be made. People didn’t have a lot of options in the past. Now they can keep people alive well beyond where they once would have died.
Personally? I don’t think hydration or nutrition should ever be withheld from a patient (who can take them) in order to hasten death. On the other hand, I witnessed a loved one die a very long, excruciating death from cancer. There was point where the person no longer existed, and the only apparent options left were horrible, unremitting pain or drug-induced unconsciousness.
There’s a point where death is a blessing. I don’t want a doctor hastening my death, but I also don’t want one trying to keep me alive only to suffer mind-destroying levels of pain when I’m beyond hope. Unless someone has had a loved one go through a death like that, they have no business criticizing someone who has.
I understand, from a religious perspective, that when the "body" is dying the "soul" is preparing for flight, if you will, and has no need for food or water. That the patient has a sense about this and why they request less and less water and don't want either food or drink.
I saw this occcur with my mother, who was a nurses aid for many years, and she knew how the nails start to change color as the body dies....I saw her checking hers often the last two weeks. In the last two or three days she would only ask for ice chips...to wet her lip... and then not even that.
So I have to agree fully with cancer patients when in the last mile there is no need...they're getting ready to go to their heavenly home.