Posted on 12/03/2022 7:35:23 AM PST by DoodleBob
Abstract
Patients who are in the last few days of life are often too frail to take oral fluids and nutrition. This may be due entirely to the natural history of their disease, although the use of sedative drugs for symptom relief may contribute to a reduced level of consciousness and thus a reduced oral intake.
Rehydration with intravenous (i.v.) fluids is the usual response in acute care settings, whereas the hospice movement has often argued against this approach.
The issues are complex and involve not only physical, psychological and social concerns, but also ethical dilemmas.
A review of the literature gives conflicting reports of the physical discomfort that may be attributed to dehydration in dying patients. There are many confounding variables, including the concomitant use of antisecretory drugs, mouth breathing and oral infection.
It remains unproven whether i.v. fluids offer symptomatic relief in this situation. Hospice doctors are concerned that the use of i.v. fluids gives confusing messages to relatives about the role of medical intervention at this stage in a patient's illness. A drip may cause a physical barrier between a patient and their loved one at this important time. The use of other methods of fluid replacement are discussed.
In the absence of definitive research in this area, the balance of the burdens and benefits of such treatment remains subjective. The prime goal of any treatment in terminal care should be the comfort of the patient. Decisions should be made on an individual basis, involving both patients and their carers wherever possible.
Prolonging life in such circumstances is of secondary concern and i.v. fluids given in this context may be futile. The ethical dilemmas of withholding and withdrawing medical treatment in addition to those of conducting research in this area are discussed.
(Excerpt) Read more at pubmed.ncbi.nlm.nih.gov ...
The old man pulled through, but the hospital refused to put Dad back on fluids or nutrition because - you guessed it - "comfort care" IN THAT HOSPITAL and for THAT DOCTOR is effectively Terri Schaivo-style starvation and dehydration.
They said, food and water was a medical treatment and thus "curative" and AGAINST the rules of "comfort care."
My friend was stunned. And the attending and her team wouldn't budge. For the next few days, my friend and siblings heard from scores of nurses etc that withholding fluids was effectively "the right thing to do"....very Terri Schaivo-like.
It took a virtual miracle whereby a different doctor intervened, said the father clearly wasn't terminal, and put the old man back on nutrition and fluids. While my friend's Dad passed away peacefully in his sleep a few weeks later, it was on his terms.
Euthanasia is, technically, illegal. And I know many people would be OK if fluids were withheld when it is THEIR time to go. Fair enough.
But clearly, as this old article and new examples prove, euthanasia can be made legal if you're not careful with Fine Print or vetting the "mercy killing" mindset of the attending.
I’m not a doctor, but it’s my understanding that dehydration is not a fun way to go.
Possible ping of interest.
Given enough drugs, it might not be as bad, but still, it’s not gonna be pleasant for sure, and I’m not sure they give enough drugs to keep a person so drugged out thatmthey don’t realize what is happening.
It should be that a person is “made as comfortable as possible while dying”, and that woild include keeping them hydrated, and as pain free as possible. It seems unconscionable to allow someone to slowly die of thirst or even hunger.
I'm with you - I was ALWAYS told that dehydration is painful, not just because of the lips but a variety of other problems.
What's incredible, is the amount of pro-dehydration "education" out there. Get a lot of this word salad:
When oral intake is poor or not recommended, the use of intravenous fluids may be thought of as a method of preventing dehydration. In a dying individual, intravenous fluids may cause more harm than good. First is the discomfort and potential for infection related to maintaining an access to administer the fluids. The body may be unable to effectively process the fluids, leading to swelling in various areas of the body. Intravenous fluids will increase the amount of secretions an individual has, resulting in coughing spells and/or shortness of breath. Lastly, fluid that goes in will also cause the bladder to fill. Fatigue and physical pain may make toileting difficult, or the individual may be incontinent and experience discomfort with the frequent skin care needed to prevent breakdown. A catheter may take care of the incontinence issue, but is another potential source of infection, in addition to the discomfort experienced with its insertion. When allowed to dry out naturally, normal chemical changes in the body and brain may produce a mild euphoria and improve an individual’s comfort level. This euphoria may allow for lower doses of narcotics or other medications to be used, thus reducing the side effect of increased sedation and allowing for more quality time with loved ones. Does dehydration still sound cruel?
Agreed. It sounds of torture to me.
I will ALWAYS request food and water.
I will insist on minimum pain relief.
I'm a 16 yr. cancer survivor and have already been there.
I prefer to do all of my suffering this side of the veil.
I'm redoing my papers.
The doctors basically said the patient is a sack of meat and it's more "humane" to recognize that he had a good life and let him go...by doing a Terri Schaivo.
Having very clear documents AND PHILOSOPHICALLY ALIGNED FAMILY MEMBERS in power, seems the best move.
Ping to Sam, who always has great thoughts on weighty matters.
Stopping eating and drinking is a natural part of the dying process.
It is one thing to go down as the cancer consumes your body, with the pain and all.
But I don't see how dehydrating someone to make their demise quicker is any kind of mercy.
If that is someone's justification, I would rather see large amounts of opiates used.
This quote stuck out at me: "...Hospice doctors are concerned that the use of i.v. fluids gives confusing messages to relatives about the role of medical intervention at this stage in a patient's illness. A drip may cause a physical barrier between a patient and their loved one at this important time. The use of other methods of fluid replacement are discussed..."
For God's sake. Of course IV fluids might give "confusing messages to relatives about the role of medical intervention at this stage in a patient's illness", but unless you are going to actively perform euthanasia, isn't it the damned job of a physician to clearly explain to laypersons why this is not contradictory at all?
DOCTOR: I know it seems like we shouldn't give your loved one IV fluids, but while dehydration will shorten the period before death appears, it isn't our position as physicians to shorten or lengthen that interval. Our job, for those of our profession who have seriously taken and believe in the Hippocratic Oath, is to diminish the suffering of the patient. Unless we are going to outright euthanize your loved one, as one does as an act of mercy to a sick animal, deliberately dehydrating them does not do that. We don't do that to sentinent and aware human beings. Yet."
Didn’t Jeb! allow this to happen back when he was Governor here in Florida?
Schindlers accuse Jeb of torture
Fox News Shawn Hannity | 25 March 2005 | James F. Rowland
My Mom died a year and a half ago at 98 from colorectal cancer. There was no doubt she would die and for the last month of her life we absolutely could not keep her at home and after 5 days in the hospital she was transferred to a really good critical care facility.
She was there for just over 20 days when she stopped eating and drinking and was mostly unconscious. I was told she was effectively in hospice at that point. I was Insistent that they put an IV in her because I didn’t want her to suffer dehydration like Terri Shiavo. They said OK and when I came to visit the next day her hand was purple where they had tried to get a vein and finally had to go to the other hand. My Mom came around must long enough to soulfully moan my name and I was horrified that I had caused her more pain.
The people at the care facility were really nice and my Mom got excellent care but the Physician Assistant told me they usually don’t put in an IV in hospice especially if you are talking about a person’s last 2-3 days which we were. So they took the IV out and my Mom passed peacefully the next day. I almost had a nervous breakdown from guilt over the whole thing. In retrospect I don’t think the IV was necessary. I was just frantic because I’m a natural born fixer and you can’t fix death.
The key word there, is natural.
We can add "sanctioned" to natural.
In this case, those words were replaced with "administrative."
When you are actively dying, it is. When you aren’t, it’s torture.
That’s how lots of old folks, especially, get finally done in: they intentionally get sent home without the fluids they need to stay alive.
Yes. Once you are dead.
Dying is, yes, at times natural and at times not. In the context of the statistical fact that the last almost three years of Covid and the now-famous Fauci-CDC "hospital protocol" involving sedative drug use alongside dangerous remdesivir and ventilation (which is why the sedatives are used), the mortality rate for Covid -- though low in real terms -- has been four times as high in the US as in the world in general.
Dying is, yes, at times natural and at times not. Especially when government makes the decisions.
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