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Terminal dehydration is dehydration to the point of death, potentially as a suicide method. Some scholars make a distinction between "terminal dehydration" and "termination by dehydration".[1] Courts in the United States[2] generally do not recognize prisoners as having a right to die by voluntary dehydration, since they view it as suicide.[2][3] As terminally ill patients approach death, their desire to consume food and fluids tends to diminish. Although it is common practice to hydrate such patients, there is some evidence that dehydration may actually be more comfortable for these patients than hydration.[4][5]

ProgressionEdit

During terminal dehydration, the usual symptoms of dehydration, such as headache and leg cramps, can occur. Dehydration can be hard to bear,[6] and requires patience and determination, since it takes from several days to a few weeks. This means that unlike many other suicide methods, it cannot be accomplished impulsively.[7] However, a "point of no return" can eventually be reached at which, should it be desired to abort the terminal dehydration, rehydration cannot be accomplished through simple oral rehydration therapy; rather, it will require medical assistance such as intravenous therapy. Those who die by terminal dehydration typically lapse into unconsciousness before death, and may also experience delirium and deranged serum sodium.[8] Discontinuation of hydration does not produce true thirst, although a sensation of dryness of the mouth often is reported as "thirst." The evidence this is not true thirst is extensive and shows the ill feeling is not relieved by giving fluids intravenously but is relieved by wetting the tongue and lips and proper care of the mouth. Patients with edema tend to take longer to die of dehydration because of the excess fluid in their bodies.[9]

VoluntaryEdit

Terminal dehydration has been described as having substantial advantages over physician-assisted suicide with respect to self-determination, access, professional integrity, and social implications. Specifically, a patient has a right to refuse treatment and it would be a personal assault for someone to force water on a patient, but such is not the case if a doctor merely refuses to provide lethal medication.[10][11] But it also has distinctive drawbacks as a humane means of voluntary death.[12] One survey of hospice nurses in Oregon (where physician-assisted suicide is legal) found that nearly twice as many had cared for patients who chose voluntary refusal of food and fluids to hasten death as had cared for patients who chose physician-assisted suicide.[13] They also rated fasting and dehydration as causing less suffering and pain and being more peaceful than physician-assisted suicide.[14] There can be a fine line between terminal sedation that results in death by dehydration and euthanasia.[15]

Studies have shown that for terminally ill patients who choose to die, deaths by terminal dehydration are generally peaceful, and not associated with suffering, when supplemented with adequate pain medication.[16][17][18][19][20][21] All ages may feel sudden head rushes, dizziness, and loss of appetite, as well.

InvoluntaryEdit

In the Netherlands, debate has broken out about terminal dehydration, which is referred to as versterven. There have been accusations that involuntary dehydration takes place in nursing homes.[22]

See alsoEdit

ReferencesEdit

  1. JK Hall (2005), After Schiavo: Next issue for nursing ethics, JONA's Healthcare Law, Ethics and Regulation, http://journals.lww.com/jonalaw/Abstract/2005/07000/After_Schiavo__Next_Issue_for_Nursing_Ethics.9.aspx 
  2. 2.0 2.1 NL Cantor (1987). Legal frontiers of death and dying. Indiana University Press. ISBN 0-253-33290-7, pp. 28-29.
  3. NL Cantor (2006), On Hastening Death Without Violating Legal or Moral Prohibitions, LoY. U. CHI. LJ, http://law.bepress.com/cgi/viewcontent.cgi?article=1026&context=rutgersnewarklwps 
  4. D Barham (2002), Students' corner. The last 48 hours of life, Contemporary Nurse, http://www.contemporarynurse.com/archives/vol/13/issue/2-3/article/1855/the-last-48-hours-of-life 
  5. G VandeKieft (2005), Who decides? An ethics case consult for Terri Schiavo, American Journal of Hospice and Palliative, http://ajh.sagepub.com/cgi/reprint/22/3/175.pdf 
  6. Effects of Dehydration. Symptomsofdehydration.com. URL accessed on 2012-04-01.
  7. SA Terman (2001), "Determining the decision-making capacity of a patient who refused food and water", Palliative medicine (Palliative medicine) 15 (1): 55–60, doi:10.1191/026921601672818272, PMID 11212469, http://pmj.sagepub.com/cgi/content/abstract/15/1/55 
  8. Baumrucker, Steven (May/June 1999), Science, Hospice and Terminal Dehydration, 16, American Journal of Hospice and Palliative Medicine 
  9. Lieberson, Alan D., Treatment of Pain and Suffering in the Terminally Ill, http://www.preciouslegacy.com/chap13.html 
  10. James L. Bernat, MD; Bernard Gert, PhD; R. Peter Mogielnicki, MD (27 December 1993), "Patient Refusal of Hydration and Nutrition", Archives of Internal Medicine (Archives of Internal Medicine) 153 (24): 2723–8, doi:10.1001/archinte.1993.00410240021003, PMID 8257247, http://archinte.highwire.org/cgi/content/summary/153/24/2723. 
  11. Thaddeus M. Pope; Lindsey Anderson (2011), "Voluntarily Stopping Eating and Drinking: A Legal Treatment Option at the End of Life", Widener Law Review (Widener Law Review) 17 (2): 363–428, http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1689049 
  12. Miller, Franklin G. and Meier, Diane E. (2004), "Voluntary Death: A Comparison of Terminal Dehydration and Physician-Assisted Suicide", Annals of internal medicine (Annals of Internal Medicine) 128 (7): 559–62, PMID 9518401, http://www.annals.org/content/128/7/559.abstract. 
  13. Jacobs, Sandra (July 24, 2003), "Death by Voluntary Dehydration — What the Caregivers Say", The New England Journal of Medicine (New England Journal of Medicine) 349 (4): 325–6, doi:10.1056/NEJMp038115, PMID 12878738, http://nejm.highwire.org/cgi/content/extract/349/4/325. 
  14. Arehart-Treichel, Joan (January 16, 2004), "Terminally Ill Choose Fasting Over M.D.-Assisted Suicide", Psychiatric News (American Psychiatric Association) 39 (2): 15 
  15. The Supreme Court and Physician-Assisted Suicide — Rejecting Assisted Suicide but Embracing Euthanasia, 337:1236-1239, New England Journal of Medicine, October 23, 1997, http://nejm.highwire.org/cgi/content/extract/337/17/1236 
  16. Ganzini L, Goy ER, Miller LL, Harvath TA, Jackson A, Delorit MA (July 2003), "Nurses' experiences with hospice patients who refuse food and fluids to hasten death", The New England Journal of Medicine 349 (4): 359–65, doi:10.1056/NEJMsa035086, PMID 12878744, http://content.nejm.org/cgi/pmidlookup?view=short&pmid=12878744&promo=ONFLNS19. 
  17. McAulay D (2001), "Dehydration in the terminally ill patient", Nursing Standard 16 (4): 33–7, PMID 11977821. 
  18. Van der Riet P, Brooks D, Ashby M (November 2006), "Nutrition and hydration at the end of life: pilot study of a palliative care experience", Journal of Law and Medicine 14 (2): 182–98, PMID 17153524. 
  19. Miller FG, Meier DE (April 1998), "Voluntary death: a comparison of terminal dehydration and physician-assisted suicide", Annals of Internal Medicine 128 (7): 559–62, PMID 9518401, http://www.annals.org/cgi/pmidlookup?view=long&pmid=9518401. 
  20. Printz LA (April 1992), "Terminal dehydration, a compassionate treatment", Archives of Internal Medicine 152 (4): 697–700, doi:10.1001/archinte.152.4.697, PMID 1373053, http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=1373053. 
  21. Sullivan RJ (April 1993), "Accepting death without artificial nutrition or hydration", Journal of General Internal Medicine 8 (4): 220–4, doi:10.1007/BF02599271, PMID 8515334. 
  22. R Pool (2004), "You're not going to dehydrate mom, are you?": Euthanasia, versterving, and good death in the Netherlands, Social Science & Medicine, http://linkinghub.elsevier.com/retrieve/pii/S0277953603005781 

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