Steven Lippmann, M.D.
Assuring good hydration is a goal for physicians. Proper fluid and electrolyte balance is vital. Yet, dehydration in selected clinical circumstances is beneficial and medically indicated, especially in near death terminal circumstances.
Providing for comfort is important to all healthcare. And comfort care is the primary treatment plan for sick people near the end of the life when recovery is unlikely. Palliation becomes the main objective. No one wishes to prolong an unpleasant death. Dehydration can become an important part of comfort care and a way to shorten the process of dying.
Dehydration is not conventionally a doctor’s first treatment option; however, in some cases it can diminish nausea, vomiting, or diarrhea, and then with less incontinence that would decrease skin breakdown. It can also improve lung function with less dyspnea, coughing, or choking. Being less hydrated can diminish the discomforts of ascites and edema. Dehydration can also augment analgesia. It tends to shrink tumors that induce pain from being in a confined space. Relative dryness also augments opioids and other pain medicine efficacy when with less body water present.
Honoring patient’s rights to autonomy over treatment choices is important in medical practice. When the balance of joy and/or meaning in life is outweighed by pain-and-suffering in terminal circumstances, many people would not want to prolong their life, nor prolong their death. This remains true regardless of a family or the doctor’s feelings. Ordering a dehydration plan calls for discussion by the patient, family, and physician, and, if elected, it is easily instituted or stopped and remains at the patient’s control. They can continue or discontinue fluids any time, at their own discretion, as a personal choice. Some people may drink or moisten their mouth at their own wishes; that facilitates control, better feeling, and interpersonal connections.
Not eating and/or drinking is a means to shorten life, but it removes the stigma of suicide, doctor’s assistance, and guilt among family members. This treatment is a reasonable option when the balance of a painful, unpleasant life outweighs an unlikely future for joy in quality-of-life. It remains a discretionary strategy by a decisional patient’s own wish and is without additional discomfort. Keeping dying people physically alive when suffering without hope for recovery, becomes a burden on patients, families, healthcare systems, and everyone else. For a non-decisional person, family members can institute a dehydration plan if they know that that is the wish of that relative. The bottom line: keep dehydration as a therapeutic option to facilitate comfort in people with near the end of life, so as not to extend an unpleasant death.