Decision makers also worry that by not choosing ANH, they are dooming the patient to a long and painful death. Reports from conscious dying patients indicate that thirst and appetite decrease naturally at the end of life. Conscious elderly patients slip quickly into a coma that is free of pain; observation of unconscious patients indicates that their dying process is quite peaceful. If the body is shutting down in preparation for death, artificial hydration— the process of giving intravenous fluids— can actually cause distress. The body is unable to rid itself of excess fluids at this time, and they can build up in the lungs, making it hard to breath.
In an article that appeared in the Journal of General Internal Medicine, the authors point out that we seem to have lost sight of the difference between a person who dies because they stop eating and drinking, and one who stops eating and drinking because of the natural dying process. Hopefully in the future, we will have clinical studies that define more clearly when the use of ANH in advanced PSP adds quality as well as quantity to a patient’ s life and when ANH inhibits the natural process of dying.
Summary
With this basic information in hand, we hope you will discuss and draw up your wishes in conversation with your family, your physician, and an experienced social worker or nurse. Doing so will provide you with control over decisions about your care even if you are unable to communicate in the future and will provide your family or agent with valuable information about your care wishes.
Resources
• American Bar Association • 800-285-2221 • www. americanbar. org
• Compassion and Choices • 800-247-7421 • www. compassionandchoices. org
• Family Caregiver Alliance • 800-445-8106 • info @ caregiver. org • www. caregiver. org
• National Academy of Elder Law Attorneys • 520-881-4005 • www. naela. org
• National Hospice and Palliative Care Organization Caring Info • 800-658-8898 • www. caringinfo. org
• National Institute on Aging Advance Care Planning • www. nia. nih. gov
• National POLST Paradigm • 202-780-8352 • info @ polst. org • www. polst. org
• State medical societies in the U. S. by state • www. emedevents. com • www. thedoctors. com
• Values History from University of New Mexico Institute for Ethics • 505-272-4566
• hsc-ethics @ salud. unm. edu • https:// hscethics. unm. edu / directives / values. html
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