Quality of death good in hospice patients who refuse food and water

Terminally ill patients who opt to end their lives by forgoing food and drink appear to die at least as peacefully as those who end their lives with physicians’ assistance, according to a survey of Oregon hospice nurses released on Wednesday.

The survey, the first systematic study of outcomes when dying patients intentionally refuse food and fluids, suggests that people facing death have a simple, serene and legal way to end their lives. Proposals to legalize physician-assisted suicide have sparked intense controversy in the United States. The practice is only legal statewide in Oregon. The Oregon nurses’ survey, published in the July 24 issue of The New England Journal of Medicine, looked at an alternative to physician-assisted suicide. Study author Dr. Linda Ganzini, director of the Palliative Care training program at the Portland Veterans Affairs Medical Center, said that some doctors considered voluntary death by dehydration to cause unnecessary suffering. She hopes the study will change some minds. “We are not at the point of saying this is a reasonable alternative for everyone,” Dr. Ganzini told Reuters in an interview. “But it is a possibility for many more patients.” She noted that in hospice patients, the normal thirst and hunger mechanisms may not be intact. The nurses surveyed in the study rated 102 deaths among patients who refused food and fluids, and 55 deaths where the doctor prescribed high-dose barbiturates. On a 10-point scale, where zero reflected the most comfort, the nurses typically rated the peacefulness of the dehydration deaths as a 2, compared with a 5 for physician-assisted suicides. On suffering and pain scales, the nurses said patients who voluntarily stopped food and fluids seemed slightly more comfortable. “According to the nurses’ reports, most deaths from voluntary refusal of food and fluids were peaceful, with little suffering, although 8% of patients were thought to have had a relatively poor quality of death,” the researchers said. Study authors conceded that there were several limitations to their research, however. For one, the death reports from hospice nurses were based on memories and perceptions that may have happened up to four years previously. Most of the patients — 85 percent — died within 15 days of giving up food and water.(Source: N Engl J Med 2003:349:359-365: Reuters Health: Gene Emery: July 24, 2003: Oncolink)