Withholding food and fluid in a dying patient

Jay-Jay, RN · Dec 19, 2004

My husband died in November, of cancer. He, too, enjoyed icy cold water to drink. As he got weaker, he lost the ability to swallow safely, due to a stroke he'd had back in January of this year. He had already developed aspiration pneumonia by the time this was recognized. I told him what was happening, and he said "I find that very difficult to accept." I did, too, especially after I tasted the thickened water. It tasted like library paste. Lemon flavored library paste, but library paste nonetheless. I felt so bad for him, I cried. He was already taking very, very little in the way of food, and his weight was down to 120 lbs.

The swallowing became a non-issue, anyway, as he began to sink so rapidly after this that by the next day, he was all but unresponsive. He died the next evening.

So, in my way of thinking, if a patient is dying anyway, give them what they want. Yes, you risk aspiration pneumonia hurrying the end, but, at this point, we should be thinking 'quality' of life, not 'quantity'!

laurakoko · Dec 19, 2004

Jay Jay, I cried at your post, and am praying for you, and your family, as you cope with your loss. It must have been a grave experience to endure, thank you for sharing your story.

CapeCodMermaid, RN · Dec 23, 2004

I've told my health care proxy that under NO circumstances will I ever drink thickened liquids. Give me plain ice water...if it goes into my lungs it'll be absorbed...or better yet, give me a piece of steak and a chocolate milk shake and if I choke on it ... at that point who cares.

steff_rn1 · Dec 31, 2004

The original post said that the patient was on Hospice, had advanced Alzheimer's disease, and was evaluated as unable to swallow safely. I have cared for patients like this, and many do reach a point where they are unable to eat and drink because they no longer have the strength, the cognition, or the desire to. In the dying process, the body requires less and less food and fluids because it is in the process of shutting down. I can imagine that if the resident had a "diet as tolerated" order, some staff would try to give them things they could not safely take it. When we care for Hospice patients, we follow their guidelines of patient comfort and working with the family to make decisions regarding their care. I see nothing wrong with NPO status when that time comes.

beesnest · Dec 31, 2004

If a patient is dying I would want a diet as tolerated order, and would give them whatever they asked for.

MedicGram · Apr 23, 2005

I would have to say anything in question pertaining to the life of another human being, be treated accordingly. That would be comfort, compassion, etc. Withholding fluids is cruel, it's starvation. And yes, be very careful with a DNR. It means "do not resuscitate" not "do not treat" also, (correct me if i'm wrong) if a DNR is in place with proper paperwork etc., the family/spouse can change their mind "on the spot" if they choose which may be a sudden, unexpected act on their part out of emotions, etc. I've been out of the loop for a bit but if there was the slightest doubt, all I remember is what I don't do/document can come back to bite big time.

when it's my time, just give me an IV with texas tea from sam diego's [long island ice tea] and open it wide-yes an IV and please swab my mouth with it too cuz I would hate to be so dehydrated and dying of thirst!!! just open it wide and let me go warm and wet!

barefootlady, ADN, RN · Apr 23, 2005

I may be facing this issue sooner than expected, I know I will never allow loved one to "NPO" because of staff concerns. Mouth care and swabs are little to do or ask when loved one is dying. IV will be a decision made at that time. NG tube no. G tube will be discussed with daughters. They will want it and one will go to court to make certain it is an option. I know this because of recent family member who did not get one and now family is having guilt issues. Losing a loved one, even if you are in the medical field, is no picnic. Thank goodness loved one has seen much and has talked and stated wishes to all concerned. :crying2:

BRANDY LPN · Apr 23, 2005

I had a man once in LTC who was dying who had been on a low protein diet for some months, when it was clear he was not going to last but a few more days, i was sitting at the desk and i heard a cat meowing, i looked up and his family was coming down the hall with a cat in a carrier a dog on a leash a steak dinner with several different types of cheese on the side, i stood up to see better and his eldest daughter said to me " he is dying, dont try to stop us this will make him happy, the damage is done if it shortens his life by a few days who cares as long as those days are happy" I wasn't going to even try before she said that but that scene has stuck with me. (and i charted it)

leslie :-D · Apr 23, 2005

if the patient is cognizant and wants food, regardless of a swallowing eval stating high risk for aspiration, i would give them what they want, as tolerated.

so i had a lady alert and oriented in hospice and the md ordered diet as tolerated. she had returned from the hospital with an ng tube but was very terminal. her brother, the poa, had fed her chocolate chip cookies, she aspirated and died 2 days later. aspiration pneumonia is no picnic. i told the md, " well dr. so and so, i guess she didn't tolerate it". if someone cannot safely swallow and ends up aspirating, it usually is not a peaceful death. besides the primary dx they have, they now have to contend with aspiration pneumonia; and yes, breathing is labored, wet and highly uncomfortable. so yes, i do have problems with fdg someone, especially alzheimer's or the severely demented, being fed with an order 'diet as tolerated'. from my experiences, they don't tolerate it at all.

leslie

leslie :-D · Apr 23, 2005

I had a man once in LTC who was dying who had been on a low protein diet for some months, when it was clear he was not going to last but a few more days, i was sitting at the desk and i heard a cat meowing, i looked up and his family was coming down the hall with a cat in a carrier a dog on a leash a steak dinner with several different types of cheese on the side, i stood up to see better and his eldest daughter said to me " he is dying, dont try to stop us this will make him happy, the damage is done if it shortens his life by a few days who cares as long as those days are happy" I wasn't going to even try before she said that but that scene has stuck with me. (and i charted it)

did your pt. have dysphagia? if not, then that's fine. but if he did, how did he tolerate the steak dinner?

leslie

studious · May 1, 2005

We had a lovely gentleman, who after surviving a Japanese prisoner of war camp, ended up with parkinsons disease later in life. As his condition deteriorated he started to choke quite a lot. He was still able to tell us what he wanted though. We told him of the risks of not having a modified diet(dietician,consultant etc:), and he accepted the risks with the same courage he'd endured during the war. He even seemed to rally for a while, brussell sprouts were his favourite vegetable and thick toffees were his favourite sweet (candy). If we even attempted to cut his food up or suggest thickened fluids, he would just give us a look of complete contempt, yip, even managed that with his Parkinsons. It was an honour and a privelege to look after him. He eventually decided when it was his time, and took to his bed (something he did not do even when ill), dying very peacefully with his family beside him.