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Question from wondering on 10/10/2013:

someone I knew was terminal and died of cirrhosis and was unconscious for awhile. when one of the children asked the hospice doctor if hydration would be of help, the doctor said it might make things worse because of fluid filling the lungs so the hydration was not administered. the patient woke up after a few days and was extremely thirsty and drank a lot, then slipped into unconsciousness again and died about a week later with visible signs of dried cracked and sticky lips. My questions are (1) can hydration make a condition worse, and (2) could the patient have suffered the pain of dehydration even though unconscious?

Answer by Judie Brown on 10/15/2013:

Dear Wondering

Not knowing enough by the specific case you are discussing I cannot comment on the suffering associated with the pain of dehydration. But I do know that hydrating a patient is not extraordinary unless the hydration does cause a threat to the patient's life. It is a legitimate argument to suggest that the lungs if not the entire body would be negatively effected by hydration.

However I also received this professional medical insight which I hope is helpful to you as well:

I, as chief medical officer, put forth a policy, which was accepted by the medical staff (some 700+ physicians) which states that "basic hydration and nutrition will be administered to the point at which the body can no longer accept them". I borrowed this statement from Pope John Paul II. Basic nutrition and hydration are considered "ordinary means of care". There are times however, such as seen with total renal failure or pulmonary edema secondary to an irreversibly failed heart where fluids can no longer be tolerated and in fact will worsen the condition. The same holds true for nutrition where obviously in total intestinal obstruction nothing can be tolerated by mouth or in the case of intravenous nutrition, a failing liver or kidney can no longer detoxify these nutrients resulting in a worsening of the condition as well. At this point, basic nutrition and hydration cease to be ordinary means of care and may be discontinued. As with all ethical decisions, each case must be thoroughly examined and only then can an ethical, moral decision be reached. I tell my medical students to remember the I/E ratio. I (intelligence) must supercede E (emotion). Whenever this ratio is reversed, a bad decision usually follows. The tragic decision made in the Terri Schiavo case is a prime example of this. Her body was able to accept nutrition and hydration but emotion over-rode intelligence here and she was in effect, euthanized. Anthony N Dardano, MD, FACOG, FACS

Judie Brown

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