“You matter because you are you. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but also to live until you die.”

Dr. Cicely Saunders, Hospice founder

Our society has strong feelings related to providing nourishment as an expression of love. Not doing so causes us to feel guilty and confused about what to do. Dying is a natural process that is not easily understood. There may be many decisions and choices to make, and many questions that need to be answered. Treatment decisions related to nourishment are frequently very difficult. Here are some thoughts about what is happening in the body as it is preparing for death and comfort measures that can be provided to your loved one.

What is happening in the body?

We eat and drink to live. Food and fluids, symbols of life, give us energy to stay alive. As we begin to die, it is natural that eating and drinking should slow and then gradually stop. The body is not dying because of not eating . . . the body is not eating because it is dying. The body is telling us that it needs a different kind of energy . . . not the energy from food or fluids, but the spiritual energy that continues to provide for us.

What if I have to help make a decision about giving artificial fluids to my loved one?

You may be asked to help your loved one make a choice on whether to receive artificial fluids (for example: IV fluids or tube feedings). This can be a very difficult decision to make. It is important to feel you have made the right decision if you choose to withdraw or withhold artificial fluids. Any uncertainty and doubts should be shared and discussed with your family members. Decisions that are made as a family unit are less likely to result in conflict at a later time, thus assuring that the wishes of your loved one will be carried out. Suggested options include:

• Talk openly and honestly with your loved one so that their wishes are known
  
• Share information and the wishes of your loved one with other family members
  
• Talk to your doctor and nurse about the pros and cons of artificial fluids
  
• Schedule a family conference with your doctor to discuss the options
  
• Ask questions freely . . . no question is too small or unimportant
  
  

What happens if the decision is made not to give artificial fluids to my loved one?

Research has found that artificial fluids become more of a burden than a blessing to the dying patient. The absence of artificial fluids can cause beneficial physical changes to occur in the body. As the body goes through natural dehydration at the end of life, the cells can no longer tolerate fluids. As the dying process continues, death will come in its own time, in its own way. The death journey will be unique for each person. Literature and our experiences support the following advantages of natural dehydration at the end of life.

• Pain awareness and restlessness decrease
  
• Fluid in the body tissues and urine output decrease
  
• Nausea and vomiting decrease
  
• Secretions and difficulty swallowing decrease
  
• Difficulty breathing, cough, and congestion decrease
  
  

What symptoms could I expect my loved one to experience?

There are very few symptoms associated with natural dehydration at the end of life. These symptoms can be controlled with good mouth care:

• Temporary thirst
  
• Dry mouth
  
• Bad taste
  
  

What can I do to make my loved one more comfortable?

The decision to not give artificial fluids does not mean nourishment or liquids would be withheld should your loved one desire them. The following are comfort measures that you can offer:

• Offer ice chips and sips of cool nonalcoholic beverages as tolerated
  
• Offer Popsicle or frozen tonic water to suck on
  
• Lubricate lips with Vaseline, Chap Stick, K-Y jelly, or moisturizer
  
• Apply mineral oil to inside of mouth with a sponge stick
  
• Use peroxide diluted with water for a mouth rinse (1/4 C peroxide: 3/4 C water)
  
• Use a saliva substitute or a salt water misting spray to the mouth (1/4 tsp. Salt: 1 C water)
  
• Comfort and touch your loved one
  
• Avoid the use of hard candies and lemon and glycerin swabs
  
  

Does natural dehydration cause death to occur more quickly?

Dehydration does not cause death, but reduces pain and allows the dying process to take its natural course. Always remember that the cause of death is the underlying illness, not the absence of artificial fluids. Your loved one no longer wants or needs the physical nourishment of feel or fluids. Your most essential task is to provide emotional nourishment, love and support, to your loved one. In this way we have changed the focus from cure to comfort care.

How do I know if I have made the right decision about artificial fluids?

Your loved one is listening and responding to the needs of his or her body. Their body no longer wants to be bothered. Although foods and fluids have fueled healing in the past, now they may only bring about discomfort and possibly even pain. Your loved one no longer wants to have distress and is withdrawing from this life. They do not want to suffer to live; they just want to live comfortably until they die.

Enjoy the time you have left together. See that your relationship with your loved one is a clear, healthy, open, honest, and caring as possible. You can be most helpful by accepting their decision to let go. Tell them that, sadly, you are ready to let go. Tell them that you love them deeply and assure them that those they love will be all right. Give them permission to let go of this life and complete their journey peacefully.

Presented by TLC/Palliative Care & Hospice of St. Peter’s
2475 E. Broadway, Helena, MT 59601

About | Services | Find a Doctor | Nursery | Education & Events | Jobs & Volunteers | Foundation | Health & Wellness | Home | Sitemap | Contact |
Patients | Visitors | Physicians | Employees
Copyright 2006 St. Peter's Hospital, all rights reserved -- 2475 Broadway, Helena MT 59601 -- Phone (406) 442-2480