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
To add to what everyone else has said, as the body is shutting down, the GI tract is one of the first that calls it quits, potentially even while the person is still awake. Forcing food on someone with a GI tract that’s not awake can be very uncomfortable/painful. In general the rule at hospice is if the patient asks for food/water, they’re given it. Otherwise they’re not forced
Thanks everyone. This has all been a great help. We watched my partner’s mother die in a hospice just a couple of weeks ago. The care she was given was second to none. Wishing you all peace and comfort.
Not going into details but there is a significant moral and legal difference between not providing futile care and actively hastening death.
I would just prefer to get it over with via a massive dose of opiates. Let me drift off to sleep and never wake. No need in drawing out the process and making my loved ones suffer seeing me in a state that they’ll likely remember long after I’m gone.
My mother choked on a piece of meat, putting her in a vegetative state and while there was no love lost between my mother and I, the mental image of her that I remember most is of her with the loud ventilator going and her chest exaggeratedly rising and falling with the sound. Not all the stuff I remember about her when I was a kid, but THAT memory is stuck with me as the memory of her.
No sir, remember me at my best, not at my worst.
I was a hospice nurse. Hospice philosophy is about promoting quality of life while they’re alive with an end stage debilitating illness, and helping ease the discomfort of their passing. Allowing nature to run its course. The sedative drugs namely morphine and lorazepam are not always used to induce sedation. Often times the dosing is low to manage symptoms of a disease. Morphine for pain in a cancer patient for example or shortness of breath in a COPD patient.
Once the dying process starts, in many cases the body shuts down non essential functions. Turns out, that usually includes losing consciousness before morphine and lorazepam are being routinely given around the clock. There is an emphasis on usually there because I’ve seen people who don’t go through that part of the process in which case, the morphine and lorazepam are used for the sedative effects in high enough doses to ease their transition. The medications are used to alleviate the discomfort of a disease that was already transitioning them to the end of their life.
As a double boarded hospice physician, this question is full of misconceptions which are stated as facts. I’ll go through them as they appear in the question.
>Patients in hospice care are often unconscious due to high doses of sedative drugs
Wrong. Patients are usually unconscious because they are dying. We only give patients sedatives if they are agitated, which does happen at the end of life and is referred to as ‘terminal agitation’. If someone is anxious we will also order them a sedative as needed, but the concept of patients being unconscious due being routinely given ‘high doses of sedatives’ is erroneous.
>and are given no intravenous fluids, which leads to death by dehydration.
Again, this is simply untrue. The patient is dying, which is why they are in hospice. Giving IV fluids would do nothing except prolong the dying process (which is no kindness for the patient or their family), and in many cases would actually accelerate death from fluid overload due to poor cardiac function; the patient literally drowns in their bed. The patient dies because their illness has left them unable to eat or drink, which can lead to things like kidney failure, not from dehydration.
>Is there any difference between this and physician-assisted suicide?
Yes, there is a huge difference. Again, these people in hospice are ACTIVELY dying from their illness and are being given everything to make their deaths as easy and painless as possible. We don’t try to shorten or prolong life but instead focus on improving the quality of life however we can. Physician assisted suicide is just that- helping someone who is terminally ill but NOT actively dying and who likely has some significant amount of time left to end their life.
I am 79 and have chosen Do Not Resuscitate as an end-of-life option. I am glad to see that most people who responded to the question are well-educated in the mechanics of dying. There is a hospice nurse on Youtube who explains very well what can be expected at the end of life. If you’re interested, search Youtube for hospice nurse Julie.
Look into DNR (do not resuscitate). The short answer is it’s not “physician assisted”… you have the right/agency to deny medication/food or to be or not be in a vegetative state.
Assisted suicide brings up thorny ethical & economic issues.
They’re going to die anyway. They have a terminal disease with a prognosis of death in the near future.
When someone chooses hospice, the goals for their care change. In general with healthcare the goal is to treat a disease to prevent complications and prolong life. When someone chooses hospice care, the goal is to make their end of life as comfortable and easy as possible.
There are uncomfortable symptoms that are common at the end of life- pain, nausea, shortness of breath, anxiety, etc. So we give pain medicine, anxiety medicine, nausea medicine, etc.
Giving IV fluids does not alleviate any of those symptoms. Giving IV fluids will prolong life while not reducing symptoms/providing comfort. In addition, the kidneys start failing as someone is dying, which means they can’t process and pee out fluids they get. Giving IV fluids would mean they get “fluid overloaded,” causing swelling all over their body and fluid to back up into their lungs and make breathing difficult. So we don’t do it.
We are not killing them by withholding IV fluids. We’re just not artificially prolonging their life. So they may be dying of dehydration, but that dehydration is a natural part of dying from their disease. We allow that natural process to happen so that they can have as peaceful and painless death as possible.
The body gets really mad when something is wrong, which is normally a good thing because it tells us to go to the doctor. When the doctor can’t fix the problem, medicine shushes those angry signals so they can rest and enjoy what time they have, kind of like snoozing an alarm.
Some people need lots of medicine to be comfortable, many need very little. Hospice helps find that sweet spot of comfy but not knocked out, and most of the time it is based on the patient and family’s preference.
Latest Answers