Hospice Patients Alliance: Consumer Advocacy


PROLONGING LIFE IN THE ACTIVELY DYING



While hospice is concerned with comforting the dying and not actively prolonging a patient's life by treating a disease, it is sometimes desirable to try to put off a patient's death for a little while...and it can be done. You may have never heard about such a possibility and may ask why would a terminally ill person, who's at the very end, want to hang on any longer. On the other hand, many of you would want to extend life at any point.

Unfinished Business

Dying is about finishing up the "unfinished business" of one's life and preparing for what's to come. Family members may need to express long held back feelings. Time is sometimes so short that family members may not have had time to even travel to be at their loved one's side. If family members live in different States or even countries, distance becomes a great obstacle to family members who wish to be at the bedside at the time of death. It is not always easy to predict the exact moment when a person will actually die. However, there are signs that an experienced hospice physician or nurse will look for. It is possible, in general, to know when the patient is in the "active phase" of dying, with only a few days left of life. If the family is far away or otherwise unable to arrive immediately, the approach of death creates problems in "getting there" on time.

When a patient receives a terminal diagnosis, they may have only a few days left, a few months, or longer. If there are only a few days left, family start to travel from all directions. If the patient becomes unresponsive and the blood pressure is dropping, family may not be able to reach the bedside on time to say "goodbye." In the acute care hospital, when blood pressure drops too low, the physicians order medications ("vasopressors") which increase the blood pressure back to the normal range. When a patient has a terminal illness and is dying, the physician will not order these medications to prolong a patient's life. The patient's comfort becomes the focus of medical care, and when death occurs is not an issue for the physician. However, it is an issue for the patient and the family.

Many medications (given to the terminally ill for pain or terminal agitation) actually lower the patient's blood pressure as a side-effect. Although these side-effects are not desired, the medications are necessary to control the pain or agitation and help keep the patient comfortable. When the patient has not been taking in fluids for days, or has been taking in such small amounts that dehydration is setting in, the blood pressure drops lower and lower as a natural part of the dying process. However, the patient and family always have the right to take whatever food or drink they wish, as long as the patient is capable...and, some drinks have effects on the blood pressure in a manner similar to "vasopressors" given in the hospital...they increase blood pressure.

The other action taken in hospitals to save patients whose blood pressure is dropping dangerously low, is to give fluids. You've probably heard of emergency room physicians ordering Intravenous fluids ("IV") immediately ("Stat") for patients who are losing blood and whose blood pressure has dropped dangerously low. Getting fluid into a dying patient may cause serious problems and discomfort if the patient cannot handle more fluid. For example, the lungs may be filling up with fluid and giving more fluid can make the problem much worse. But in the case where the lungs are not filling up with fluid, giving extra fluid by mouth or feeding tube can bring the blood pressure back up long enough for the patient to say "goodbye." It is important to be able to "let go" of the patient when the patient is really ready to pass on, and prolonging the life of a dying patient who is ready to go, is not ethical. Death is a natural part of the life cycle. However, there are exceptions when a few hours longer will make all the difference.

Some families who knew that their loved one was actively dying and knew that a relative was traveling from afar, have given strong coffee to the patient in order to bring the blood pressure back up a little. Some patients' blood pressure increased by 30 or 40 points (or mm on the blood pressure scale). If the patient is unable to drink, some families have given a few drops of coffee at a time by medicine dropper or "oral syringe" into the mouth and let it be absorbed directly in the mouth ("sublingual"). Strongly brewed coffee given regularly every few minutes or so, in drops or by feeding tube, in some cases, can bring the blood pressure up, counteract the effect of blood pressure lowering side-effects of some narcotics and help the patient live long enough to say "goodbye" to a family member. In those circumstances where a few hours or one day can make all the difference, some families have found coffee to be of great help.






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