Dehydration & Starvation – Myths & Realities

There are many misunderstandings regarding the need for food and fluids at the end-of-life.  The following information will hopefully help you make more informed choices regarding the type of care desired.

 

Myths
Common beliefs regarding the need for food/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.”

Realities
Healthy people who don’t eat but only drink fluids, do become hungry, thirsty, and uncomfortable—and will die of starvation in 3-4 weeks.  Those who neither eat nor drink, die of dehydration and actually have no discomfort (except for a dry mouth, which is easily treated with moist sponges)!
In studies with volunteers dying from diseases like cancer, Lou Gehrig’s Disease [ALS], dehydration & malnourishment were not shown to be painful.  The lack of food and water promoted comfort because of chemical changes in the body and the brain.
When actively dying (the last two weeks of life), artificial fluids (an IV) causes discomfort:  lungs sound ‘wetter’, the bladder fills more, the brain is more aware of pain, and the sensation of hunger is enhanced.
By interfering in this final stage of life, by altering the 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 (depending on diseases present, general health, etc.)—artificial fluids can prolong this for weeks.
Families need to know that it’s the disease that causes a person to die—of ultimately dehydration—not starvation.  Prior to modern technology (such as IV’s and feeding tubes), people were described as dying of “natural causes” and not as “starving to death”.

Conclusions
At the end of life:  (1) dehydration is not painful, (2) providing IV fluids does not help for comfort, (3) IV fluids can prolong death, and (4) a dying person does not “starve” to death.
As a loved one declines, everyone can be reassured that avoiding artificial interventions just allows “nature” to take its course and proceed as intended, peacefully.

 

References
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.


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