There are many misunderstandings regarding the need for food and fluids at the end of life. The following information will hopefully help seniors and their families make more informed choices regarding the type of care they desire.
The following are commonly heard statements regarding the need for food and fluids as we approach the end-of-life.
1. “Dehydration & starvation are painful.”
2. “Providing IV (intravenous) fluids will make a terminally ill person more comfortable.”
3. “We cannot allow someone to starve to death.”
We all know that healthy people who don’t eat or drink adequately become hungry, thirsty, and uncomfortable. But, in studies with volunteers dying from different diseases (e.g., cancer, congestive heart failure, oxygen-dependent emphysema, kidney failure, dementia), dehydration & malnourishment were not shown to be painful. The lack of food and water actually promoted comfort because of chemical changes that occurred in the body and in the brain.
For folks who are actively dying (as in the last week or two of life), the artificial (i.e., intravenous) administration of fluids usually causes discomfort. The lungs retain water, the bladder fills more often and wants to be emptied, the brain is more aware of pain, and the sensation of hunger is enhanced.
By interfering in this final stage of life, by altering this normal chemical process, artificial hydration delays death and prolongs suffering. If we allow “nature to take its course”, almost everyone who is terminally ill and is unable to swallow fluids will die within two to ten days. If we supply artificial fluids through an IV, this can take weeks.
It is helpful for families to remember that it is the disease that causes a person to die, not dehydration or starvation from the withholding of fluids or food. Consequently, “starvation” is the incorrect term to use in cases of terminal illness. Prior to the medical inventions of intravenous lines and feeding tubes, people died of “natural causes” and were not thought of as “starving to death”.
Thus, at the very end of life: (1) dehydration & starvation are not painful, (2) providing IV fluids does not keep a terminally ill person more comfortable, (3) IV fluid administration can prolong death, and (4) a dying person does not “starve” to death. As a loved one declines, everyone—families, friends, seniors, doctors, and nurses—can be reassured that if the choice is made to avoid artificial interventions, “nature” will take its course and proceed as intended, peacefully.
1. Ng K. Symptoms and attitudes of 100 consecutive patients admitted to an acute hospice/palliative care unit. J Pain Symptom Manage. 1998.
2. McCann R, et al. Comfort care for terminally ill patients. JAMA. 1994.
3. McGeer A, et al. Parenteral nutrition in patients receiving cancer chemotherapy. Ann Intern Med. 1989.
4. Fainsinger R. The management of dehydration in terminally ill patients. J Palliat Care. 1994.