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?
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Yes. There is definitely a difference between being denied life-saving medication and being given a drug that kills you. It basically comes down to issue of medical malpractice and patient consent. In general, you have the right to decline any medication you want, you don’t have to right to RECEIVE any medication you want.
So in the case of assisted suicide, a patient is essentially asking a doctor to provide them with medication in a scenario that would constitute malpractice. In the situation of hospice, the patient is simply declining the care that would prolong their life.
In his final few days we stopped feeding my dh as he had requested. He was almost totally unconscious. I took a nap and a caregiver forced two ensures down him, prolonging his unconsciousness and death by days. why on earth is this seen as a good thing?
I volunteered in a hospice for 9 years. Your observations do not match my experiences.
Hospices are for end of life care, not the moment of death. This is because they’re not hospitals and death is not always a gentle drift away. The hospice I worked at could allow you to die there, but it was very complicated and uncommon. The majority of people were there for a few weeks respite.
I’ve never known of a hospice patient have high dose sedatives, or forced dehydration. If a patient was unconscious they would have been transferred to hospital care.
Once your kidneys shut down when your body is dying, fluids are not gonna help really. If you end up just forcing fluids into a person who can’t balance it out. That just ends up leaving the bloodstream and going somewhere else.
The body gets very swollen, the skin tears very easily, their skin leaks fluid, the lungs get filled and the person can’t breathe, and they have so many secretions they are choking on their own saliva.
It’s not necessarily in someone’s best interest to get overloaded with fluids if there already is nothing more to do.
There have been some very good in depth comments, so here is a tl;dr
Those patients do not die because they are not eating and drinking.
They do not eat or drink because they are dying.
This is sadly a common misconception about hospice, and often prevents people from seeking hospice care when they could have greatly benefited from it. Misinformation such as this can also cause surviving family members to feel guilt or responsibility for the death of their loved one because they happened to be the one administering medication to keep that person from suffering. Others have already explained why this is wrong so I won’t repeat the information already given. I just want you or anyone else who reads this to know that hospice care is never intended to shorten someone’s life expectancy, neither is it intended to extend life for the sole purpose of keeping the heart beating. It is all about maximizing the quality of life for however long that person has, along with providing support and education to the patient’s caregivers so that they have a better understanding of what is happening and how to care for a person that is dying.
IV fluids artificially prolong life. You can receive IVF in hospice if that’s on your care plan – typically as a comfort measure – but a person can linger for days or weeks, even if they’re not eating or are not awake, if they are on IVF. That’s not ideal for dying people.
There is a difference between allowing death and causing death.
If there was no option to allow death, we could keep many people alive indefinitely, way past the point of reason, simply because we have the technology.
Broadly, most would argue, we currently lean too far towards prolonging life instead of allowing natural death.
Hi. I’m a hospice nurse. So there’s a ton of misinformation that goes around about hospice care. Let’s start from the beginning of your sentence. “ unconscious due to high doses of sedative drugs”. We only give people medications when there are symptoms. For instance, if a patient is having respiratory distress or in pain at end of life, we will administer morphine. Usually at a very low dose, around 5 mg. Then we will watch and see how effective this medication is, and when it begins to wear off. From there, we can determine if we need to increase the dose and determine how often the medication should be given, such as every 4 to 6 hours. A side effect is being drowsy, but the patient is either in pain and having respiratory distress so this is why it is given. Another commonly use medication is lorazepam. Again this is only given when a patient begins to experience restlessness or agitation. There is something called terminal agitation and restlessness, you can do some research on why this occurs but people typically need lorazepam or Haldol administered. Again we start at the lowest dose, we assess and determine the dosage and frequency needed based on how each person reacts to it. Another side effect of lorazepam is drowsiness. The patient has to determine what they want; comfort care, which is the definition of hospice, OR to live in pain, respiratory distress, or agitation and restlessness. And that’s why hospice is so important, because we help you die comfortably if that’s what you want. The next part of your statement says “ are given no intravenous fluids, which leads to death by dehydration”. This is also not true. As the body begins to shut down, it no longer requires or wants food or fluids. Your organs are shutting down and putting things inside your body, upsets it and makes it very uncomfortable. You can think of it as waking something up that doesn’t want to be woken. You do not die because you’re dehydrated or are starved, you die because your body was dying from whatever disease it had. Hospice care is completely different from assisted suicide. We do not administer high enough dosages to overdose someone, which sort of seems what you’re implying that is done. Assisted suicide is taking medication with the intent to die. Hospice care is taking medication to keep you comfortable during the natural dying process. I hope this helps, and I hope you can help spread the word and advocate, for why hospice is important, because it really makes things difficult when people have a stigma about something that isn’t correct. I have an uncle who literally thinks I kill people for a living. But when you’re on the other side of things, you truly understand the importance of dying comfortably. we’re all going to die sometime, i’ve seen some pretty terrible deaths from patients whose family members held these important medication‘s from them because of their own beliefs. The outcome was still death, and it was extremely uncomfortable and painful.
The difference between this and “Physician Assisted Suicide” is that you are already **actively** dying. There is no saving the person. There is only prolonging the death. Hospice is about making this as painless as possible.
Physician assisted suicide is **actively** ending the life. Imagine someone in the exact same condition as the hospice patient… and instead of giving them painkillers the doctor gave them poison. That would be assisted suicide. Hospice is about letting the body perform the dying naturally. It doesn’t speed it along at all (assisted suicide) but it doesn’t try to stop it… which would only fail and cause the dying process to last much longer anyway.
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