Voluntarily refusing food and fuids to hasten death

tewdles, RN · Nov 12, 2009

When people are dying they most often lose their appetite and desire to eat and are allowed to refuse foods and fluids, this would be one type of Voluntarily refusing food and fuids to hasten death. I am absolutely ok with that.

Occasionally we are consulted in cases of longer term illnesses where extraordinary measures have been taken in attempts to sustain life. Those families sometimes to withdraw TPN or enteral nutrition when it becomes obvious that the condition is terminal. If the person is unable to take oral nutrition they die. This represents a second type of Voluntarily refusing food and fuids to hasten death. I am absolutely ok with that.

hisgeogal · Nov 16, 2009

I'm not a hospice nurse (or a nurse yet) but if it helps, you can add my comment to your paper.

My mother had terminal colon cancer. We were blessed to be able to care for her at home while she passed. She was on TPN for a couple of weeks but then her hospice nurses noticed a crackling in her lungs and mom had a hard time breathing. No fluid coughed up, just difficulty breathing. The hospice nurse said that fluid was getting into her lungs due to the TPN. The nurse explained it to me first and then I gave her the green light to explain it to mom, it was her life after all. We then gave mom the choice whether or not to stay on the TPN. I told her it was her choice, I'd do whatever she wanted to. If she wanted to stay on the TPN, I'd be more than happy to continue ordering it for her. If she wanted to go off of it, I'd get the pharmacy on the phone the minute she changed her mind.

She decided to go off the TPN, choosing instead to be able to breath freely during the majority of her last days. Sure enough, she was able to breath right again within a day or two. It was painful for me knowing she was going to, in effect, starve to death but she was going to die, there was no doubt, and knowing the majority of that time would be much more comfortable for her made it easier.

She was still able to eat popsickles which helped ease her hunger until she finally did get to that point in her "transition" where she just didn't want to eat anymore. She said the smell of food didn't even phase her.

I used to question whether or not we should have tried to encourage her to stay on the TPN but to see her suffocating the last few weeks before she passed would have been much worse and I felt deceitful on our part if we didn't tell her why she wasn't able to breath. She's in an infinately better place now!

tewdles, RN · Nov 17, 2009

hisgeogal...eloquently and beautifully stated. You honored your mother.

4treasures · Nov 17, 2009

Thank you for sharing. That must be a very painful desicion to make, but I commend you for doing it for your mother.