No, I don't think food and water are withheld to expedite the process for caretakers. Was your stepmother able to sit up and swallow water? That may be the deciding factor.

for my mother there was a huge choking factor involved. She was to the point she could not sit up at all just the bed raised a little and if she tried to drink from a straw or chew she would choke badly. They would use an eyedropper to give tiny sips of water.

My mother couldn't sit up on her own. The nurse's comment about defeating the whole purpose is what started me on this train of thought.

No. My grandfather was diabetic. They stopped his insulin injections that last few days. It was just letting nature take its course. I've been told he woke up a day or two before and seemed more alert and played with my then 2 yo cousin, but was not able to talk. After that, he didn't wake again that I know of and slipped away peacefully without any more intrusion. I don't believe he was in any pain.

My fil died in hospice of a brain tumor. There was some previous discussion of whether to use an iv or not when the time came. I'm not sure what his decision was. I wasn't there either. Giving fluids prolongs the agony for both the dying and the grieving. The absence of it allows natural processes to take place. Sometimes we extend life when maybe we shouldn't.

I had to stop giving my Mom liquids in the last few months of her life because of her swallowing issues, She did love those lemon sponges and I would make sure to wet her lips and tongue. I was horrified when I was told not to give her liquids. She never drank much water but she loved her tea. I did use that liquid thickener for some things like juices. Not having liquids didn't bring her death on faster, she just got it other ways like in her food. My sister on the other hand chose not to eat in the last few weeks of her life. She also wasn't able to drink a lot of liquid at once but I sat at the side of her bed giving her ice chips which she always wanted. My Aunt did the same thing, she was in Hospice and refused to eat or drink anything. She wanted her death to come faster. I would talk to her on the phone trying to convince her to eat and drink but she refused. I would hate to think caregivers withhold food or drink to hasten death.

A dear relative passed on recently and she was never denied water, to my knowledge; I'll ask her daughter when enough time has passed. She grew to refuse food, but up to that time her daughter and caregivers gave her anything they thought she might like.

I want to add that I do think it's cruel to withhold water! I know there's often a choking concern, but surely there's a way to deal with that.

>> I do think it's cruel to withhold water! >>

Please don't confuse the responsiveness of someone in a vegetative state with that of someone who is mentally/physically alert.

It may help to read this analysis at: http://www.todaysdietitian.com/newarchives/082508p68.shtml

Briefly, the relevant passage is as follows:

" The notion that withholding nutrition support contributes to pain and suffering has also been debated. Positron emission tomography scans have demonstrated that when a patient is in a persistent vegetative state, the brain areas responsible for pain perception do not function. Therefore, providing nutrition support to this patient population to provide comfort and reduce suffering is not science based. Some studies of patients who are dying have indicated that thirst and hunger are not a significant problem when patients decide to forgo nutrition support and hydration. A study of nurses caring for terminally ill patients who voluntarily chose to stop food and fluid intake reported the nurses’ median score of the quality of the patients’ deaths as 8 (range: 0 equaled very bad death and 9 equaled very good death). For patients with irreversible or terminal illness, it appears that nutrition support may not benefit the patient but may increase suffering and hasten death. " "

The last time I checked with a hospice, the patient can specify in advance whether or not to allow transfusions, hydration, nutrients, dialysis, a respirator. These are all appropriate as life preserving measures, in hospital. You should be able to refuse them in hospice when you are dying. Making this clear is as important as putting DNR on your chart.

I don't see it as 'witholding' but as a decision not to prolong my wait for death. I'll accept an IV if it is needed to administer pain meds.

Ice chips and lip salve are pretty standard.

This may be a case of poor choice of words rather than anything bigger. Perhaps the hospice nurse meant that the purpose of the lemon sponge was to provide moisture without stressing the patient, and the purpose being defeated by giving liquid which needed to be swallowed was that of easing the patient without suffering in the inevitable end. Often, it seems, dehydrated people don't actually feel thirsty. The lemon sponge may have been refreshing and the flavor enjoyable when little else was.

I don't know either way, but I do know that it's easy to latch onto one little thing and put all one's difficult emotions onto it. Perhaps it might help to set your mind at ease if you interview the manager of the hospice agency and ask about how they handle such procedures. It could also be helpful for the agency for their training. Knowing how to handle such questions without causing anxiety for the loved ones should be an important matter.

Actually, my stepmother died 20 years ago. It came to mind today because I've been going over the new health care power of attorney sent to me for my signature. I was half glazing over, reading the legalese, but sat up straight when I read that I was authorizing my children to

"withhold or withdraw nutrition (food) or hydration (water) . . . "

But then the rest of the sentence reads "medically supplied by tube . . . "

Thanks, Jakkom. That's interesting. I can see how someone terribly sick would refuse food or water. I'm not sure how providing nutrition support would increase their suffering and hasten death, though, unless it is forced on them. "Voluntarily" must be the key.

Alisande was your stepmother on pain medication? When my mother passed she was on quite a bit of morphine and wasn't conscious the last few days. I'm not sure if she was getting any hydration, I think it's likely she wasn't, but I doubt she would have been aware of anything either. She was groaning a lot at times as if she was in pain, but tbh I don't think she would have knowingly been aware of any pain either. I do agree with the poster above who said there is a difference between an alert state and what we may be seeing from the outside.

I guess as a sort of comparison, a couple of years ago I had a hemorrhagic stroke and was in hospital for a month. Apparently I was often conscious and talking (although not making much sense), but I actually don't remember most of it. When I finally became lucid after a few weeks, it was quite overwhelming to find out everything I'd been through as I had a tough time with complications, but I just wasn't really aware of what was happening. I do remember vividly a few times waking up and feeling like I was in some strange dream, then I was out again, and like I said, I was actually conscious quite often from what I was told.

So I suspect when someone is in the last days, they are probably even less aware of what is happening around them than that and her response to the lemon sponge may have just been a bodily reaction but not even something that registered with her.

When my step sister passed away on January 2nd she was in hospice. Her mom had made the decision to not prolong life anymore which meant stopping insulin and dialysis. She had not eaten anything for about 4 days before she was admitted into ICU, so no food or water was given to her ( she was unconscious). I know she was getting pain medicine some how, just not sure. She was also on oxygen. I think all of these decisions were hard to make, but along with my step sisters health and medical professions, these decisions had to be made.

Trancegemini, I don't think she was on pain meds. I'm sorry you had to go through the ordeal of the stroke, and hope your recovery has been as complete as it certainly appears to us.

The hospice nurses told me hearing is the last to go. I took it to heart at the time, and have kept it in mind at other goodbyes.

I was very sick with salmonella over 20 years ago, and remember being unable to speak or move in the hospital, but I could hear people talking around me.

There's a big difference with tubes. You can definitely force things the dying body doesn't want and sustain the idea of life past when the body is ready to die. An IV of fluids is different from a sip of water, or even a glass. Those suppose that the systems for ingestion and utilization are working correctly. The tubes push sustenance through whether or not the alimentary system can handle food and water. Great for a severe trauma from which the patient will heal if he can be kept alive long enough. Not so much when it's forcing a dying body, well past any thought of recovery, to keep going.

We recently filled out those same papers with/for my parents and under advisement from my husband who went thru this with his mother and his experience with being an EMT and in and out of nursing homes, we opted to not withhold hydration. He watched his mother die over the course of a week and said it seemed more painful and was so hard on both of them, to withhold fluids.

When my elderly friend was nearing the end, the hospice nurses stopped food & water;

they said that her digestive system & kidneys were no longer working, & that food & water would cause her more pain.

I hate it when people say things like "that would defeat the whole purpose".

Do they think that they're some sort of angels of death, with a mission to make sure their patient departs as quickly as possible?

or do they think the family/friends/caregivers are either not entitled to information or are too stupid to understand what the "professionals" know?

I have done hospice care on patients. Food and water is not denied to a patient who can tolerate them if the patient desires it. Usually as a person becomes closer to passing they lose their desire for food, but they do not lose the desire for liquids until they are unconscious. If a patient aspirates liquids (choking, coughing) they may be able to tolerate thickened liquids. Denying a patient liquids when they desire them and can tolerate them is never done by an ethical caretaker. Hospice is about making a patient comfortable as they pass to the other side. It is not about hastening the process.

i guess I was very lucky...mother went on hospice and died 3 days later...I tried to moisten her lip that last day but it really did nothing...i'm sure she was on some sort of morphine as she had a very bad back...I was was grateful she had ins that allowed her to stay in the nursing home...

Hospice's website has a page, that describes the dying progress. HospiceFluid and Food Decrease
The person may have a decrease in appetite and thirst, wanting little or no food or fluid. The body will naturally begin to conserve energy which is expended on these tasks. Do not try to force food or drink into the person, or try to use guilt to manipulate them into eating or drinking something. To do this only makes the person much more uncomfortable. Small chips of ice, frozen Gatorade or juice may be refreshing in the mouth. If the person is able to swallow, fluids may be given in small amounts by syringe (ask the Hospice nurse for guidance). Glycerin swabs may help keep the mouth and lips moist and comfortable. A cool, moist washcloth on the forehead may also increase physical comfort.

But I don't think hydration-only will extend life for very long. The idea of being desperately thirsty and not able to drink makes me feel panicky.

sjerin - As long as a person has fluids, they can survive a surprising length of time depending on the amount of fat and muscle their body has.

"As long as a person has fluids, they can survive a surprising length of time depending on the amount of fat and muscle their body has."

gmatx- This typically does not apply to a terminally ill patient who is in hospice because they have an active disease process or catastrophic injury.