Is starvation a painful way to die?

Discussion in 'Community Board' started by Chicago526, Mar 22, 2005.

  1. Chicago526

    Chicago526 <font color=red>Any dream will do...<br><font colo

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    I read this article on Chicago Tribune's website. I thought I'd share, since a lot of DISer's are following the Terri Schiavo case.

    Is starvation a painful way to die?
    Suffering is uncommon, experts say

    By Jeremy Manier
    Tribune staff reporter
    Published March 22, 2005

    http://www.chicagotribune.com/news/...2starvation,1,6855148.story?coll=chi-news-hed

    One of the main rationales of religious advocates and lawmakers seeking to keep Terri Schiavo alive through a feeding tube has been that removing her only source of nutrition and liquid would be cruel, leading to a "horrible and painful death," in the words of one activist.

    But many of the doctors and nurses who witness the consequences of removing such treatment from patients say withholding nourishment is a common—and largely painless—way of letting nature take its course for ill patients. They say many people near death actually choose to have their feeding tubes removed, which typically leads to a calm, peaceful death.

    Most of the experience comes from patients whose cases may differ from that of Schiavo, who has survived for 15 years in a persistent vegetative state. But experts say Schiavo, who is in a Florida hospice, likely would be given the same simple care that makes feeding tube removal an easy way out for many patients and their families.

    The most common problem is a dry mouth and thirstiness, which caregivers treat with moist swabs and ice chips, if a patient is able to swallow. Those are steps Schiavo would have needed for some time, since she hasn't taken food or drink through her mouth since the 1990 heart stoppage that left her permanently brain damaged.

    None of the doctors, nurses and hospice employees interviewed for this article said they have ever seen removal of a feeding tube increase suffering of a hospice patient.

    "I've helped thousands of people be comfortable at the end of life," said Dr. Michael Marschke, medical director for Horizon Hospice in Chicago. "Most stop eating on their own, and they're very comfortable doing it."

    Some hospice workers said they feel the controversy over Schiavo has placed their mission in question. They also criticized what they described as bad information put out by lawmakers who over the weekend moved to allow a federal court to decide Schiavo's fate.

    Rep. Jim Ryun (R-Kan.) said that Michael Schiavo, by testifying that his wife would have wanted the tube removed, "sentenced her to a most excruciating death."

    'They're wrong'

    "I listened to those representatives, and I was appalled," Marschke said. "They're wrong. To talk like that is an injustice to the public."

    A 2003 survey of Oregon hospice nurses whose patients had chosen to speed death by refusing food or fluids found that those patients experienced relatively little apparent pain or suffering. About one-third of the nurses contacted had at least one patient who chose that course in the previous four years, according to the study, published in the New England Journal of Medicine.

    Most of the deaths "were peaceful, with little suffering, although 8 percent of patients were thought to have had a relatively poor quality of death," the authors wrote.

    Advocates for Terri Schiavo's survival insist the dehydration process is painful, and they have cited the experience of one former patient, Kate Adamson, who had her feeding tube removed and has described it as "torture." But most people who provide end-of-life care said her story is not typical.

    Some patients feel hungry for two or three days after the withdrawal of food, but experts said it's a surprisingly short-lived sensation. After that the body begins a process called ketosis, getting energy from fat stores.

    Many experts believe that chemicals released in the process have the effect of relieving hunger and may even give rise to a feeling of euphoria. Oddly, having even a little food at such times may create more hunger than complete starvation.

    "Within a few days, you're not very hungry," said Dr. Jeff Frank, a neurologist at the University of Chicago who has watched many patients die after having feeding tubes removed. "When you eat something, you actually feel uncomfortable."

    Studies have shown that feeding tubes do not produce the same feeling of satiety that normal eating produces. Therefore, removing a tube probably does not result in the same sort of hunger that a normal fast would, Frank said.

    Patients become sleepy

    Lack of water makes the body stop producing urine in an effort to conserve fluid. The body retains more sodium and waste products, some of which tend to make patients sleepy.

    "You get a level of sedation that enhances comfort," said Nancy Harte, a registered nurse and director of the Rainbow Hospice LIFE Institute for Learning in Park Ridge.

    After a week or so, the patient's blood pressure decreases, and eventually blood carbon dioxide levels increase, starting a terminal spiral. More carbon dioxide lowers blood pressure further, making it harder for the body to get enough oxygen. The increase in carbon dioxide has a separate sedative effect, often called "CO2 narcosis." Most patients die of an infection or from cardiac arrest.

    Many experts said it's only natural to assume that withholding water and food would be painful. Susan Dolan, executive director of Des Plaines-based Seasons Hospice, said her staff has a name for such reactions: "The out-of-towner syndrome."

    "The family at the bedside has accepted what's happening, then sister Sue shows up, sees that Mom has lost 50 pounds, and she has a knee-jerk reaction," Dolan said. "It's the same thing with Terri Schiavo; if you're hearing about this for the first time, it's like, 'Oh my gosh, they're starving her, do something.'"

    Doctors said one risk of the crisis may be to cast suspicion on the practice of removing feeding tubes. One bill that passed the U.S. House last week but failed in the Senate would have given federal courts broad power to review the removal of feeding tubes.

    Marschke of Horizon Hospice said such measures would take away what is, for many families, the best option.

    "There are lots of patients dying this way," Marschke said, "and now their family members will be concerned they're doing the wrong thing. All for the sport of politics."
     
  2. brermomof2

    brermomof2 DIS Veteran

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    I don't know about that. But I've heard dying from dehydration is excruciating.
     
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  4. Chicago526

    Chicago526 <font color=red>Any dream will do...<br><font colo

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    The article addresses dehydration as well, and states that it is not usually painful.
     
  5. brermomof2

    brermomof2 DIS Veteran

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    hmmmm.......well, I don't think I'll volunteer to try that out.
     
  6. Lisa F

    Lisa F is a very wise woman

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    My DH's grandmother died that way and it was pretty consistent with what the article said. She no longer needed dialysis and was grateful to have a few days of peace without it. She could not eat because the food would aspirate into her lungs. She was lucid enough to tell you how she felt many times in the days before she died but never lucid enough to grasp the decisions that were being made for her. By the time she stopped eating she had already been living on so little food and had so little activity that her metabolism was quite low anyway. It's not the same as taking an energetic healthy person and withholding food. She never asked for food one way or the other and was fed by hospice attendants before she started aspirating into her lungs. The decision was to stop feeding her (as the pnemonia caused by the aspiration WOULD have been painful) and not to put in a feeding tube either.

    She died very peacefully and never claimed to be in any pain in her last days. It was a difficult decision for her two sons to make but when they saw how at peace she was in her last days and heard about how peaceful she was when she died, they knew they had made the right decision.

    edited to add: She was not on any pain meds either. Her metabolism was already SOOO slow, it eventually just stopped. Hers was probably the most peaceful death that I have ever heard of personally.
     
  7. JennyMominRI

    JennyMominRI <font color=red>Live from Red Sox Nation<br><font

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    If you or I was starved and denied water it would be painful..However,if we were given meds for pain it would not be.. For someone with no cerebral cortex,it would be painless
     
  8. MosMom

    MosMom <font color=deeppink>Damn you, you wretched clown!

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    My aunt dehydrated to death after a long battle with cancer and even though hospice was present and she was heavily medicated it was still a gruesome death. There is no reason in the world she should not have been able to receive a shot and drift away peacefully. Euthanasia laws are BS.
     
  9. Christine

    Christine Would love to be able to sit on

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    I think dying of starvation is probably VERY painful for a healthy person who is suddenly thrust into that situation; i.e., getting stuck in the desert. But if you are very sick and aren't taking food in normally, I think it is a very different situation.
     
  10. brermomof2

    brermomof2 DIS Veteran

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    You all have good points. I'm not trying to be gross, but curious.....will she "wither up" before she dies?
     
  11. sweet angel

    sweet angel DIS Veteran

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    I can't imagine starvation not being painful. When I'm really hungy I get light-headed, headachy and nauseaus (not to mention really, really cranky)...I'd think it would be even worse if it was prolonged. Apparently I'm wrong though.
     
  12. Chicago526

    Chicago526 <font color=red>Any dream will do...<br><font colo

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    Well, I think it's a differant experiance for otherwise healthy people to die from lack of food and water! A person with multiple medical conditions that would lead a patient or their family to remove a feeding tube has so much else going on that I don't think their body registers the lack of food/water.
     
  13. Denine

    Denine I want to go on a cruise! I want to move to sunny

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    When you are dying, dehydration actually is a pain killer. It is a peaceful way to go.
    I do not know how it is if you are not actively dying.
     
  14. Lisa F

    Lisa F is a very wise woman

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    Not to doubt you or anything but isn't cancer extraordinarily painful? So how do you know that the deydration was the painful part? I agree with you about euthanasia btw. I'm just saying that if someone already has an incredibly painful disease, you can't really tell what is causing the pain. In the case of my DH's grandmother she wasn't in any pain nor was she on any pain medication at the end and she showed no signs of discomfort, only peace.
     
  15. vettechick99

    vettechick99 <font color=purple>Why do I open these threads?<br

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    ITA! What's the difference in "putting her to sleep" vs. withholding water & food? The end result is death either way and one simple shot could save a lot of suffering - for everyone involved.

    Why is it ok to put dogs and cats to sleep, but not humans - who in some cases - beg for it? So sad.

    :confused3
     
  16. Chicago526

    Chicago526 <font color=red>Any dream will do...<br><font colo

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    I think this is the most telling part of the article. That there are people (unlike Terri) who ARE aware and ACTIVELY choose to have feeding tubes removed. If it were painful, I think these people would very quickly ask to have the tube reinserted.
     
  17. DawnCt1

    DawnCt1 <font color=red>I had to wonder what "holiday" he

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    Not at all. We are being told by some segments of the media and certainly by MS that it is actually a pleasant, comfortable way to go. The electrolyte consentrations rise and we slip into a blissful, comfortable, peaceful sleep. In fact, this new revelation will have impact on future policy decisions. Up until now we have tried to devise ways to put the condemned to death. Starvation is the way to go in the future. Think of the money it will save in drugs such as potassium chloride, pentathol and succinyl choline. It will totally eliminate the inconvenience to the prison systems for the last meal. It won't be needed. Yup. Just when we thought lethal injection was humane, we now learn that starvation is even better. Why, the inmate will not even have to be moved to a holding cell cutting down on any need for new construction.
     
  18. Lisa F

    Lisa F is a very wise woman

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    I think it is the natural way of things. Elderly people require fewer calories than young people do. Their metabolisms are slower. Left to their own devices at the end of their life they would not eat (at least in my experience). Heck, my grandmother is 87 and has a pretty good quality of life for someone her age and we have to remind her to eat constantly. She just doesn't get all that hungry. I think feeding tubes do serve a purpose for someone who has a chance of healing and recovering but at the end of someone's life they are just in the way of the inevitable.
     
  19. chris1gill

    chris1gill <a href="http://www.wdwinfo.com/dis-sponsor/index.

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    My Husbands Grandmother died this way last August 1st... She was quite old, and had really reduced (naturally) what she was eating... my MIL kept trying to literally push food & water, it just wasn't working. I knew that nature was taking its course, and after speaking with her doctors, MIL was told the very last thing she needed to do was to try pushing nutrition... the time had come for GMIL, and it was her bodies natural way of dying. She was 99, but otherwise in quite good health right up until a year before. She was in no discomfort the last week, none at all....

    I would have been more concerned if I didn't have a good friend's MIL who died two years away this way... and she related the story to me... the final week her MIL just stopped taking nutrition on her own, she wasn't hungry, she was dying from cancer... she did receive pain medication from that, but as for not taking food, she had no pain from it....

    After having sort of gone through this with these two cases, I'm so very certain that our bodies know when they are finished & it's a natural progression to occur, not at all unusual... JMHO....
     
  20. shelbyjosh

    shelbyjosh <font color=purple>DVC/OKW Member<br><font color=t

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    I saw a clip earlier from Terri's doc. The part of her brain that was affected from her 5 minutes of lack of oxygen is the side that handles all the endorphins and pain. Because this side suffered, she has no pain sensation; therefore, hunger pains and pain associated with lack of hydration and nutrition will NOT be felt. They showed a brain CT and what normal looks like. A normal brain has a lot of "white" on the film. Her's was mostly "black" area. Her doctor also concurred that she does NOT recognize faces, voices, etc. and there wouldn't be any hope of rehabilitation.

    My thought is"

    1. Why would you want your loved one to live on TPN fed thru a tube??

    2. She is in a persistant vegetative state. Yes, she can breathe on her own but cannot sustain life on her own. Per her MD, this condition is irreversible.

    3. Terri cannot eat, uninate or deficate on her own. What quality of life does she have? I certainly know I would not want to live like that just because family members can't come to grip with the thought of loss. Let this suffering woman go in peace and keep the politicians and legal system out of the picture.

    Have a nice day!
     
  21. ThAnswr

    ThAnswr DIS Veteran

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    You can't make this stuff up. Oy, oy, oy!

    Being a nurse, one would think you would actually know the difference between a patient in a PVS and removing a feeding tube and a prisoner being executed. I guess you can't take anything for granted these days.
     

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