Therapeutic Benefits of Dehydration in the Terminally Ill
January 8, 2012
In many societies, there is close relationship associated with food and caring. The giving of food is often considered to represent compassion in the minds of most people. It is not surprising that the issue of withholding artificial hydration and nutrition is such a heavily debated topic. To make a more informed decision, patients and/or family members need to be educated about the benefits, legal, and ethical considerations of dehydration in the terminally ill patient. Literature supports that forced hydration during the end of life is of little benefit and may actually ...view middle of the document...
The benefits, legal, and ethical aspects of dehydration should always be carefully considered. When a health care provider suggests the discontinuation of life-sustaining measures, the patient’s own wishes must always be honored. The need for family and patient education and understanding are vital in the final decision making process: “The final decision should be based on knowledge; the patient should die in comfort and with dignity (Vaz, 2010, p. 2).”
Dr. Cheryl Aranella (2005) points out in her online article Artificial Nutrition and Hydration: Beneficial or Harmful? “Artificial hydration and nutrition is often more burdensome than helpful in the dying patient and alternative methods of nurturing should be implemented (p.5).” Like many medical procedures, all forms of artificial nutrition and hydration:
* Require the patient to undergo uncomfortable, and at times painful procedures while starting the treatment;
* Have known side effects and possible complications, including serious infections, fluid overload, nausea/vomiting, and death;
* Hold very little similarity to a person sitting at the table enjoying a tasty meal.
Nurturing can be expressed in other ways, such as presence at the bedside, soothing touch, talking to the patient, maintaining moisture to the mouth and lips, applying lotions, and playing the patient’s favorite music softly.
One of the largest myths regarding dehydration in the dying person is that they experience extreme thirst and pain. In fact, Dr. Aranella emphasizes that “dehydration in a terminally ill patient is not painful. In the dying patient, the majority never experience thirst; and, the thirst that occurs is easily alleviated by small amounts of fluids to moisten the mouth, and by lubricating the lips” (2005, p. 2-3). Another misconception in the dying patient who stops eating is that they will “starve to death.” Aranella (2005) explains that there is no sense of hunger in the dying patient:
When a dying person stops eating, usually it is because the illness has progressed to the point where the person is no longer able to process food and fluids. Forcing the patient to eat, or starting artificial nutrition and hydration does not help the person live longer, feel better, feel stronger, or increase their ability to do more. In fact, a person given artificial nutrition and hydration will often feel bloated, nauseated, and/or develop vomiting and diarrhea. The majority of EOL patients never experience hunger, and in those that do, small amounts of fluids, offered whenever the patient requests, relieves the hunger. (p. 3)
When the patient and/or family feels that the burdens of medical hydration and nutrition outweigh the benefits, is it then ethical to withdraw or withhold artificial nutrition and hydration? J. Lynn, MD (1989) stated in her book, By No Extraordinary Measures that “it is ethically acceptable to discontinue or decline medical hydration and nutrition if the...