Will the withdrawal of artificial nutrition and hydration lead to a long and painful death?
No. For patients who are at the end of life, death normally occurs within
three to 14 days after artificial nutrition and hydration is stopped (the time
varies depending on how debilitated the patient was when treatment was
discontinued). Reports based on the observation of unconscious patients
indicate that the process is quite peaceful, and no evidence exists that they
are aware of the process. Conscious patients who are elderly or neurologically
impaired usually will slip quickly into a coma (a sleep-like state that is
inherently free of pain) and become similarly unaware.
Caregivers of dying people and patients themselves have reported that those
who are near death are seldom hungry, and if feelings of hunger occur, small
amounts of food by mouth are usually all the patient wants. The most common
complaint is dry mouth, a condition that can be alleviated by sips of water,
ice chips, lubricants for the lips, or other appropriate oral care. On rare
occasions, patients may experience twitching or muscle spasms when hydration is
withdrawn, but these symptoms can be managed easily with sedatives. Symptoms
that sometimes occur, such as severe pain or nausea, are due to the disease
itself. Supplying artificial nutrition and hydration will not alleviate these
symptoms and may even make them worse.
Grief is defined as the primarily emotional/affective process of reacting to the loss of a loved one through death. The focus is on the internal, intrapsychic process of the individual. Normal or common grief reactions may include components such as the following:
Numbness and disbelief.
Anxiety from the distress of separation.
A process of mourning often accompanied by symptoms of depression.
Grief reactions can also be viewed...
Is there evidence that avoiding artificial nutrition and hydration contributes to a more comfortable death?
Yes. Much of this evidence is based on observations by those who have had a
great deal of experience caring for people who are dying, such as hospice
workers. They have noticed that patients who are not tube fed seem more
comfortable than those who are. Caregivers also have observed that symptoms
such as nausea, vomiting, abdominal pain, incontinence, congestion, shortness
of breath, among others, decreased when artificial nutrition and hydration were
discontinued, making the patient more comfortable. For example, patients with
pneumonia, one of the most common terminal events among elderly patients or
people with terminal illness, will not suffer as much from coughing or
shortness of breath due to excess mucous production if they are not receiving
fluids. Medical observation has found no indications that patients who have
suffered massive brain damage causing permanent unconsciousness experience any
pain when artificial nutrition and hydration is stopped.