Tales from The Departure Lounge 2

One of my patients has turned a corner - the wrong one - and she is now dying, very slowly.  I think I've posted on a similar case about a year ago, and like that patient, no food or liquid has passed her lips for 8 days now (although mouth care keeps her lips moist). She's very peaceful lying in bad, semiconcious, but her family are distressed by the idea that we are not feeding her, giving her drinks (We can't just pour them down her) or giving her intravenous fluids. Nothing for 8 days. Its a basic human instinct to want to nurture with food and drink - and even harder to accept a loved one is dying.   I should add that breakdown of body fat in this starvation situation liberates water and combined with a switching off of metabolism, water needs are much reduced. Of course, you can't ask an unconcious person what its like to not take any fluid (although she is not showing any signs of distress – we are managing her on the Liverpool Care Pathway for the Dying.) A study from Oregon of 106 terminally ill patients in hospice programmes who chose to discontinue food and fluids with the conscious intention of hastening death found that most reported a high degree of peace and comfort - 90% were thought to have achieved what is described as a "good" death. In the end I guess that even is she is not suffering, its a long slow haul for her loved ones around her bed. 

N Engl J Med 2003; 349: 359-65

 

http://www.nejm.org/doi/full/10.1056/NEJMsa035086#t=articleDiscussion