Is it necessary for someone to be hydrated during their final days?

9 answers | Last updated: Oct 07, 2016
Court asked...

Residents in my senior building have asked if it is necessary to have hydration during the final days. If comfort measures is all one wants with pain medications, isn't it better to have the fluids?

Expert Answers

Barbara Repa, a senior editor, is an attorney, a journalist specializing in aging issues, and the author of Your Rights in the Workplace (Nolo), now in its 10th edition.

How and whether a person chooses to direct comfort care and hydration as care at the end of life is very much a personal decision"”usually based on individual preferences and often on personal experiences, such as witnessing the death of a friend or family member.

The debate that seems to be going on in your building echoes the debate still raging throughout the country about terms such as "necessary," "hydration," "comfort" and "better" when it comes to directing end of life care.

Medical experts disagree on whether a patient who is comatose or close to death can feel pain"”so they also debate whether such patients benefit from pain control medications. There is also disagreement over whether administering drugs to make a person more comfortable or alleviate pain will also have the effect of prolonging the person's life.

To make matters even more complicated, controversies over artificially administered food and water still rage because medical experts disagree about whether its purpose is to is to sustain life or to cure an illness.

So unfortunately, no one can provide you with what you may seek: a simple "yes" or "no" answer.

What the controversy and confusion does underscore, however, is the importance of recording your personal preferences in an advance directive. If preferences remain unclear, make an appointment to talk with a trusted medical professional to discuss this very issue.

Community Answers

Squeakie answered...

"Experts" can debate this until the end of their OWN lives -- & get their own answers. In the real world -- has it ever been comfortable to feel extreme thirst? To wake with a sore,cracked tongue or throat because hydration was absent during sleep? What real difference would a little fluid make in the end?
Withhold pain meds just because they might 'prolong' life a little more? Well -- would we rather die more quickly, but in real pain, or slip away a little more slowly, but comfortably? For those of us who have sat watch, for days or weeks -- it may seem endless at times, but what's more important -- our comfort or the dying person's comfort? I've seen too many dying people to assume -- as we did about analgesia for babies, for years -- that any comfort measure should be withheld.

Boo answered...

I recently went through this with my husband. Hydrate is humane. They do hear you and need you to advocate for them. Bevie

Frena answered...

actually what this question ignores is that those approaching the very end of life a) don't want to drink and will refuse, if they speak at all, and b) are not able to drink. so, kindly offered fluids poured into their mouths are more likely to cause hat person to cough, choke and aspirate fluid into the lungs, causing them to develop pneumonia.

i have never been with a dying person whose tongue was "cracked and sore" with lack of hydration. not unless they were dying from being lost in the desert. so let's keep wild rhetoric out of these discussions, since it doesn't help us decide the big issues.

we should talk and explore end of life issues, but we also need to understand what the physical dying process is. for that, i recommend that everyone spends time visiting with and being in the presence of the dying. the dying themselves have for long ages been our teachers.

how sad that today most adults have never been in the presence of the dying, even in their own families.

plus i have never heard or seen that anyone's life is prolonged by pain meds, just the opposite. Hospice will routinely warn that beginning the use of morphine will begin the process of closing down healthy lung function. that's isn't its aim, but it is a side effect.

you can sign me up for the comfort drugs, thank-you very much, but i'll not worry about the food and drink.

Hsm21 answered...

I have watched, prayed over, cleaned, whispered to & fed my dear mom the very last 9 days of her life. She slowly started to refuse solids than liquids. Jello & ginger ale seemed to be the only substance I could give her. The last 3 to 4 days, however, she tightly closed her lips to any & all foods/liquids. I started giving her ice chips & those sticks with the lemon tasting sponges on the ends to keep the inside of her mouth as hydrated as possible. She eventually started to refuse those as well. I believe, in my mom's case, her body was naturally changing over from this world to the next. Sort of a preparation, so to speak. She was on pain meds. when needed, but at low dosages, to maintain comfort. She was able to provide me with glimpses of where she was going & who was there to greet her. Her main struggle was letting go. She did not want to leave me. I finally needed to reassure her that I would be fine & when it was my time to leave this world, who would be there to greet me? That seemed to relax her & shortly after that, she passed over to her Eternal Home. I shall never forget those 9 days.

Gbjamis answered...

I have owned and operated my adult Foster Home for the past 11 years. A total of nine persons have been cared for at the end of life with the help of hospice in my home. When I was asked for my own directive, I was a bit frustrated. I really do not know what I want because I personally have not been there. I have seen and cared for people and found, even though they had voiced their wishes beforehand, the real thing seemed different. My advice for everyone having a loved one facing end of life is: Be with the person, care for the person and you will see what they want. If medication makes them rest easier, well then what is the question? When the person can no longer swallow. A mouthsponge dipped in water provides comfort. Caring for a person at the end of life is draining, but also very rewarding. I personally sit with such an individual for hours, invite their loved ones to share in the caretaking if they choose to. Some people do not like to have someone in their room at all times. In such instances I get permission from the loved ones to install a babycam in the room so that I can monitor the person to see what they need and r4spond accordingly.

Frena answered...

hsm21 has it right. being with someone you care about when they're dying is a radiant, challenging, scary and wonderful time. it's the most powerful spiritual experience, no matter what your religious affiliations are or are not. going through it all with a person you care deeply about gives you answers to questions you might never have asked and helps you bring peace to your own attitudes about your own ultimate death. dying isn't a formula, though it has shape and signs and symptoms. it's the most powerful passage besides being born, giving birth and then dying itself. it's the most profoundly human thing we do and to share it is a privilege and even a consolation beyond measure. but only doing it gives you that

yayyyyyyyyy for you,msm21!

Aplynor answered...

I agree with this time being a very rewarding time, The question of comfort meds and hydration, I also agree it should be whatever the individual that is dying wants. It is their comfort and they should be able to get what they want at this point in their life. I have recently and still am, sitting with my mother as she is walking down this very path. She was diagnosed with a Non-Hodgekins Lymphoma 9 months ago. After receiving chemo, it seems to be at a minimum growth for now. Three months ago she suffered a massive stroke. The stroke has left her with her left side non-responsiveness and is now on a feeding tube, which I might add, the medical profession didn't want her to have. Thank God she did have her advance directive prepared which she had the forethought to say she wanted the artificial food and hydration. Without this she surely would be long gone by now. She also has an irregular heart rhythm and the medical profession wants to blame the cancer for any & everything wrong. It's now 3 months since her stroke and she is still not swallowing properly, asking for water constantly. The medical profession doesn't like to give much in the way of additional water either, something I think needs some extensive research done on. By the way, yes her mouth is sore, and most times very dry unless I stay on top of the swabbing, (sponges with water). If I don't stay on top of this her tongue will become very dry and crusty, and does appear to be cracking. She wants the hydration but can't get it. It seems today, the medical profession, government, (whomever is in the charge seat) doesn't want the elderly to survive once something goes wrong in their health and will hang their hat on any diagnosis that fits the reasoning for not trying to help them survive. It is a sad day, these days, when you have to fight for the right to survive with the medical professions help. I wouldn't have missed these last nine months for anything and will cherish them till my own dying days. They have taught me quite a huge bit. My hat is off to all my fellow caregivers out there! May God Bless us all when our time draws near.

Teamrn answered...

The issue of IV hydration at the end of life has been discussed for years and is a very personal one, often emotionally charged. It is often said that if you deprive a person of fluids, that you're starving him to death. It's my personal opinion after having seen the death of many,

I worked in hospice for quite some time, that at this time, there is a greater chance of vomiting. If there is a greater chance of vomiting, IVs only increase the amount that one 'vomits.' Towards the end of life, people often accumulate fluid in their lungs. With circulation often at a near standstill, there are often more fluids for the lungs to try to handle and this makes it harder on the lungs and heart.

A case may be made that IV fluids decrease mouth discomfort and dry skin. While it is true that both often exist, routine lotioning definitely helps. That laying on of hands, the comfort that the patient receives from that laying on of hands, that touch, brings more comfort than the IV can. Without being able to swallow liquids, and not having an IV, what about the dry mouth and dry lips that can follow?

Mouth swabs and lubricating products can help a lot in providing comfort and should be standard part of the care of any patient, hospice or non-hospice. The comfort provided by these are immense to both the patient and whomever is putting on the lotion.