End of life care

[Alex_G]

Sure, he was terminally ill so I just wanted to make that clear, however when he could not longer drink/eat we had him on an IV drip to give him fluids. His body may have given up at that time however his mind certainly hadn't. After receiving the IV you could see his eyes brighten and he was more responsive to what we were saying, even had the odd day where his speech would return or he'd have a giggle.

When we saw that the IV was no longer providing what he needed, admittedly not very long after the IV process began, the IV fluids were changed to IV morphine which I don't need to fill in the blanks here.

You are right though the first you mention above is much more like killing compared to someone who is terminally ill, however I feel (infact I know) that if he didn't have these fluids then we would have in effect killed him before his time by with-holding them. I think each person has to be assessed on an individual basis before deciding on whether it is genuinely helping or whether moving directly to an alternative such as morphine is the best solution. In our case it was best to start with fluids then move to morphine.

So to stop me rabbiting on I suppose what I am getting at is that I think it should always be a first option to see if there are positive results.

Your not rambling on, this is all so very insightful. It lifts my spirits to see such a post. I get the picture that you sensed a reversible effect from the administration of Iv fluids that added positively to the quality of life. Such that regardless of the terminal nature of a patient, because lets face it we could argue that we're all terminal, a worthwhile intervention was performed.

How do you think one could make that call? Without knowing the effect beforehand, someone at the end of life might never seemingly respond, with the additional fact that the administration of fluids could be directly detrimental to their well being, eg provoking painful swelling in heart failure, or simple act to prelong a state of suffering that would otherwise not happen. When and why would you rationalise a non curative or life prolonging intervention in someone with a terminal illness that has directly led them to a state of 'being' that no longer constitutes a life that can or is aware of self preservation? Where does a dignified and sensible end to life occur?

 

[ChristineES]

I answered yes. To do otherwise seems cruel.

 

[Falvlun]

It is absolutely possible, without much difficulty, to allow someone to die with dignity and pain free, without prolonging their suffering and death by giving them IV fluids. A good medical team can tell the family (and the patient when they are conscious) whether or not the patient will experience any discomfort associated with not providing an IV.

The logical answer seems to me to be to defer to the wishes of the patient, and if those wishes haven't been clarified beforehand, do whatever it is that will minimize suffering.

The hospice told us that when a person's death is imminent, their appetite and thirst level decreases to little or nothing. This was definitely true with my grandmother. She had no fluids for about four or five days, but we kept her mouth and throat hydrated. She was fully conscious till the last day or so, and was semi conscious till the very end, and not one time did she want us to give her any water or fluids (or food), though we asked her often.

She did appreciate her swabbing her lips and tongue with some substance that they provided that kept her mouth from drying out.

That's good to know.

 

[Shadow Wolf]

Unless they have a DNR and/or living will stating otherwise, keep them hydrated and alive, especially if the person is not coherent or in the proper state of mind to be making such decisions.
However I do believe that those who are terminal, suffering, and have no escape should have the option to end their own life, and if this was Mrs. S's wishes (also assuming she is not able to give consent or administer such treatment) then the best thing would be to keep her comfortable, such as not letting her mouth or throat dry, and let her pass.

 

[Iti oj]

That's not a good enough answer. We can all back out of the difficult questions in life by similar reasons, but the reality is such decisions area made every day. Whether you agree either way on my binary proposition is to miss the point, the question under the question is what makes this important to you? What drives you to answer 'this is too black and white'?

no one circumstance is ever the same. i think enlighten put it well enough.

 

[Enlighten]

Your not rambling on, this is all so very insightful. It lifts my spirits to see such a post. I get the picture that you sensed a reversible effect from the administration of Iv fluids that added positively to the quality of life. Such that regardless of the terminal nature of a patient, because lets face it we could argue that we're all terminal, a worthwhile intervention was performed.

Yes there definitely was a reversible effect, albiet short term but it was there still. I guess it comes down to knowing the person as from my experiences we (the family) could see him brighten physically from the fluids. Instances such as smiling, speech returning, even down to the colour of his skin improved.

How do you think one could make that call? Without knowing the effect beforehand, someone at the end of life might never seemingly respond, with the additional fact that the administration of fluids could be directly detrimental to their well being, eg provoking painful swelling in heart failure, or simple act to prelong a state of suffering that would otherwise not happen.

I would love to have a definitive answer to your questions, unfortunately I can only do my best to answer from my experiences. So, how would one make the call? Well I would say that it best to try to do whatever possible to make someone more comfortable when incapable of drinking/eating for themselves so it is an option to use IV fluids to monitor if it indeed improves their quality of life. Where it may be detrimental to the person then I'm sure that this is where our medical professionals would be aware and not go down this route, I guess it depends on the nature of the persons illness.

When and why would you rationalise a non curative or life prolonging intervention in someone with a terminal illness that has directly led them to a state of 'being' that no longer constitutes a life that can or is aware of self preservation? Where does a dignified and sensible end to life occur?

It needs to come down to evaluating each person by knowing them and working with the medical professionals for the best route for that person.

I think you hit the nail on the head within your question though (with added caveat). When the person is in a state of being that no longer constitutes a life, if uncurable and unresponsive, then I think this would be valid reason to allow the person to have a dignified end to life. I actually think Kathryn mentioned before about dabbing their mouth with a wet sponge etc can also help when IV fluids are not the answer and will still allow the patient to remain comfortable enough. Everyone has the right to a dignified end to life so it's up to those around to ensure that the person gets this and we are not keeping someone alive because of our personal feelings but have the persons/patients feelings or wishes at the forefront.

 

[Kathryn]

Yes there definitely was a reversible effect, albiet short term but it was there still. I guess it comes down to knowing the person as from my experiences we (the family) could see him brighten physically from the fluids. Instances such as smiling, speech returning, even down to the colour of his skin improved.



I would love to have a definitive answer to your questions, unfortunately I can only do my best to answer from my experiences. So, how would one make the call? Well I would say that it best to try to do whatever possible to make someone more comfortable when incapable of drinking/eating for themselves so it is an option to use IV fluids to monitor if it indeed improves their quality of life. Where it may be detrimental to the person then I'm sure that this is where our medical professionals would be aware and not go down this route, I guess it depends on the nature of the persons illness.



It needs to come down to evaluating each person by knowing them and working with the medical professionals for the best route for that person.

I think you hit the nail on the head within your question though (with added caveat). When the person is in a state of being that no longer constitutes a life, if uncurable and unresponsive, then I think this would be valid reason to allow the person to have a dignified end to life. I actually think Kathryn mentioned before about dabbing their mouth with a wet sponge etc can also help when IV fluids are not the answer and will still allow the patient to remain comfortable enough. Everyone has the right to a dignified end to life so it's up to those around to ensure that the person gets this and we are not keeping someone alive because of our personal feelings but have the persons/patients feelings or wishes at the forefront.

Right on.

When a person's death is imminent, the most important thing is to keep them comfortable and to minimize suffering. Depending on the individual situation, this could mean either giving or withholding fluids.

 

[Penumbra]

I voted "no", but overall, it depends on more specifics.

-If the person specifically stated ahead of time that she wanted that, and had the means to pay for it, then sure, prolong her life as much as possible if that's what she wants.

-If it's unknown, then I view the default position as not needlessly prolonging someone's life. I think society needs to fear death less, so that it can potentially reduce the suffering that could potentially occur in this sort of scenario. I would absolutely not want a doctor to prolong my life in this way.

-Overall, I think the key element is comfort, so it depends on the specific situation. When someone is in a critical and unrecoverable state, I think doctors should focus on minimizing suffering and maximizing comfort, rather than focus on delaying death.