Terminally ill patients sometimes d...

Terminally ill patients sometimes decline aliment and fluid intake to hasten death. The moral implications of this decision for patients and physicians are hotly debated, however the legal treatment of the situation is simple and straightforward: any capable person has the right to stop eating and drinking, equable if this action has fatal issues Little has been published about what patients experience when they stop nutrition and fluid intake. Ganzini and associates contemplateed hospice nurses in Oregon, asking them to describe their greatest in quantity recent patient who declined oral intake as a means to hasten death.

The authors sent questionnaires to each Medicare-certified home hospice program that serv patients in Oregon. The overall answer rate from the 429 hospice suckles surveyed was 72 percent (307 nurses) Forty-one percent of the promotes reported having a recent patient who had stopped regimen and fluid intake to hasten death. In the nurses' estimation, the greatest in number important reasons that the patients stopped oral intake were readiness to die, poor quality of life, view that continuance of life was pointless, desire to die at residence and desire to control the circumstances of death. The reasons thinked least contributory included lack of social support, previously witnessed "bad death," and depression or other psychiatric disorder. Of the 126 patients who stopped fare and fluid intake, 13 percent later resum oral intake. The greatest in number common reasons for restarting meat and fluid intake were family desire for the patient to eat and craving appetite or discomfort when not eating.

The estimated life expectancy just before the patient decided to stop aliment and fluid intake was at least united month for about one half of the patients, and les than that for the remainder. Death occurr within 15 days in 85 percent of patients after cessation of oral intake.

nourish at the breasts were asked to score the patients' final experiences in succession a 10-point scale for peacefulness, pain, of the same height of suffering, and overall quality of death. The median scores were grave for suffering and pain (2 to 3 public of 10) and high for overall quality of death (8 gone out of 10). In 8 percent of cases, however, hospice feeds rated the death experience as "bad" (score of naught to 4 out of 10) Patients who had "bad" deaths after stopping rations and fluid intake had higher than average pain and suffering scores and were somewhat younger.

The authors judge that terminally ill patients who pick to stop eating and drinking to hasten their death usually die within sum of two units weeks of that decision, with gentle levels of pain and suffering and a virtuous overall quality of death.

Ganzini L et al. Nurses' experiences with hospice patients who refuse aliment and fluids to hasten death. N Engl J M July 24 2003;349:359-65

EDITOR'S NOTE: As is their legal right, patients sometimes make decisions with which their physicians may not agree. The moral debate about whether a terminally ill patient should be allowed to stop subsistence and fluid intake as a means of hastening death could fill many tomes, further the available information about the specific experiences of patients choosing this passage is scant. Even physicians who disagree with a patient's decision to stop oral intake may benefit from having a idea of what to rely upon in that situation. Surveys may be criticized as a "softer science" manner but they do provide general data in areas in which a randomized controll trial obviously is impossible.

COPYRIGHT 2004 American Academy of Family Physicians

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