eli5: Patients in hospice care are often unconscious due to high doses of sedative drugs, and are given no intravenous fluids, which leads to death by dehydration. Why is this done? Is there any difference between this and physician-assisted suicide?

Question

eli5: Patients in hospice care are often unconscious due to high doses of sedative drugs, and are given no intravenous fluids, which leads to death by dehydration. Why is this done? Is there any difference between this and physician-assisted suicide?

In: Other

Answer 1

Trigger warning: some unpleasant descriptions of symptoms

It would rarely be dehydration that the person dies of.

At the point when fluid is stopped, it is very near the end. The person is actively dying.

Likewise the sedation/unconsciousness is often not entirely due to drugs. At the end you’ll get some people who can be agitated and disorientated for a time before falling unconscious and drugs are often used to help this, but often very low doses to take the edge off of it and make them comfortable. If they are in a deep sleep type of unconsciousness, it’s more to do with dying.

One reason for not persisting with fluids is IV access. It often becomes increasingly difficult to place and keep a cannula working and repeated attempts in a person who is fading can be viewed as cruel when they may only have hours left (final stages of dying can be difficult to estimate how long they have left. It may last hours, it may be a few days).

But a big reason for withholding fluids at the end, is that being on the dry side helps symptoms, particularly breathing. At the end, swallowing automatically can become compromised and if there is excessive saliva, or even normal levels, they can choke repeatedly. This level of sudden oxygen starvation is a horrible sensation and not what to experience over and over if it can be avoided simply. But a big one is that as the heart becomes less effective, fluid can accumulate in the lungs tissue simply. This make breathing more difficult and can be distressing. It’s like slowly drowning. Reducing hydration levels a the end can reduce this to help the end be more peaceful, for both the patient and those around them.

Fluid restriction/stopping is only done when the person is actively dying and consciousness is affected, and if they are not already unconscious, they are nearly at that stage.