Terminal dehydration

Dehydration to the point of death

Terminal dehydration is dehydration to the point of death. Some scholars make a distinction between "terminal dehydration" and "termination by dehydration".[1] Courts in the United States[2] generally do not recognize prisoners as having a right to die by voluntary dehydration, since they view it as suicide.[2][3]

## Progression

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During terminal dehydration, the usual symptoms of dehydration, such as headache and leg cramps, can occur. Unlike many other suicide methods, it cannot be accomplished impulsively.[4] However, a "point of no return" can eventually be reached at which, should it be desired to abort the terminal dehydration, rehydration cannot be accomplished through simple oral rehydration therapy; rather, it will require medical assistance such as intravenous therapy. Those who die by terminal dehydration typically lapse into unconsciousness before death, and may also experience delirium and altered serum sodium.[5] Patients with edema tend to take longer to die of dehydration because of the excess fluid in their bodies.[6] Dehydration has been known to cause a sense of "mild euphoria", provided no intravenous is used.[7]

## Voluntary

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Terminal dehydration (also known as voluntary death by dehydration or VDD)[8] has been described as having substantial advantages over physician-assisted suicide with respect to self-determination, access, professional integrity, and social implications. Specifically, a patient has a right to refuse treatment and it would be a personal assault for someone to force water on a patient, but such is not the case if a doctor merely refuses to provide lethal medication.[9][10] Some physicians believe it might have distinctive drawbacks as a humane means of voluntary death.[11] One survey of hospice nurses in Oregon (where physician-assisted suicide is legal) found that nearly twice as many had cared for patients who chose voluntary refusal of food and fluids to hasten death as had cared for patients who chose physician-assisted suicide.[12] They also rated fasting and dehydration as causing less suffering and pain and being more peaceful than physician-assisted suicide.[13] Patients undergoing terminal dehydration can often feel no pain, as they are often given sedatives and care such as mouth rinses or sprays[14] There can be a fine line between terminal sedation that results in death by dehydration and euthanasia.[15]

Studies have shown that for terminally ill patients who choose to die, deaths by terminal dehydration are generally peaceful, and not associated with suffering, when supplemented with adequate pain medication.[16][17][18][19][20][21] All ages may feel sudden head rushes, dizziness, and loss of appetite, as well.

Members of the Buddhist Sokushinbutsu sect of Japan historically practiced a form of self-mummification which in part was achieved by the forgoing of all food and liquid until death.

## Involuntary

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In the Netherlands debate has broken out about terminal dehydration, which is referred to as versterving [nl]. There have been accusations that involuntary dehydration takes place in nursing homes.[22] Another doctoral thesis found no evidence of forced-upon "versterving" in nursing homes.[23] There was, however, voiced vehement opposition [who?] considering assistance for those who voluntarily abstained from food and drink.[23]

## See also

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* Heat illness
* Hypovolemia
* Hypovolemic shock
* Fasting
* Medical food
* Terri Schiavo case

## References

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1. ^ JK Hall (2005), "After Schiavo: Next issue for nursing ethics", JONA's Healthcare Law, Ethics and Regulation, 7 (3): 94–98, doi:10.1097/00128488-200507000-00009, PMID 16148577, S2CID 45362001
2. ^ a b NL Cantor (1987). Legal frontiers of death and dying. Indiana University Press. ISBN 0-253-33290-7, pp. 28-29.
3. ^ NL Cantor (2006), On Hastening Death Without Violating Legal or Moral Prohibitions, LoY. U. CHI. LJ
4. ^ SA Terman (2001), "Determining the decision-making capacity of a patient who refused food and water", Palliative Medicine, 15 (1): 55–60, doi:10.1191/026921601672818272, PMID 11212469, S2CID 31506243
5. ^ Baumrucker, Steven (May–June 1999), "Science, Hospice and Terminal Dehydration", The American Journal of Hospice & Palliative Care, 16 (3), American Journal of Hospice and Palliative Medicine: 502–3, doi:10.1177/104990919901600302, PMID 10661057, S2CID 44883936
6. ^ Lieberson, Alan D., Treatment of Pain and Suffering in the Terminally Ill, archived from the original on 2010-02-03, retrieved 2010-06-24
7. ^ Bennett, Jill A. "Dehydration: hazards and benefits." Geriatric Nursing 21.2 (2000): 84-88.
8. ^ Park, James Leonard, VDD: Why Giving Up Water Is Better Than Other Means Of Voluntary Death
9. ^ James L. Bernat, MD; Bernard Gert; R. Peter Mogielnicki, MD (27 December 1993), "Patient Refusal of Hydration and Nutrition", Archives of Internal Medicine, 153 (24): 2723–8, doi:10.1001/archinte.1993.00410240021003, PMID 8257247, archived from the original on 26 July 2011.
10. ^ Thaddeus M. Pope; Lindsey Anderson (2011), "Voluntarily Stopping Eating and Drinking: A Legal Treatment Option at the End of Life", Widener Law Review, 17 (2): 363–428, SSRN 1689049
11. ^ Miller, Franklin G. & Meier, Diane E. (2004), "Voluntary Death: A Comparison of Terminal Dehydration and Physician-Assisted Suicide", Annals of Internal Medicine, 128 (7): 559–62, doi:10.7326/0003-4819-128-7-199804010-00007, PMID 9518401, S2CID 34734585.
12. ^ Jacobs, Sandra (July 24, 2003), "Death by Voluntary Dehydration — What the Caregivers Say", The New England Journal of Medicine, 349 (4), New England Journal of Medicine: 325–6, doi:10.1056/NEJMp038115, PMID 12878738.[permanent dead link]
13. ^ Arehart-Treichel, Joan (January 16, 2004), "Terminally Ill Choose Fasting Over M.D.-Assisted Suicide", Psychiatric News, 39 (2), American Psychiatric Association: 15–51, doi:10.1176/pn.39.2.0015
14. ^ Voluntary Stopping of Eating and Drinking: An Ethical Alternative to Physician-Assisted Suicide, vol. 24, Ethics, Law, and Policy, January–February 2015
15. ^ The Supreme Court and Physician-Assisted Suicide — Rejecting Assisted Suicide but Embracing Euthanasia, vol. 337:1236-1239, New England Journal of Medicine, October 23, 1997, archived from the original on February 22, 2010
16. ^ Ganzini L, Goy ER, Miller LL, Harvath TA, Jackson A, Delorit MA (July 2003), "Nurses' experiences with hospice patients who refuse food and fluids to hasten death", The New England Journal of Medicine, 349 (4): 359–65, doi:10.1056/NEJMsa035086, PMID 12878744.
17. ^ McAulay D (2001), "Dehydration in the terminally ill patient", Nursing Standard, 16 (4): 33–7, doi:10.7748/ns2001.10.16.4.33.c3095, PMID 11977821.
18. ^ Van der Riet P, Brooks D, Ashby M (November 2006), "Nutrition and hydration at the end of life: pilot study of a palliative care experience", Journal of Law and Medicine, 14 (2): 182–98, PMID 17153524.
19. ^ Miller FG, Meier DE (April 1998), "Voluntary death: a comparison of terminal dehydration and physician-assisted suicide", Annals of Internal Medicine, 128 (7): 559–62, doi:10.7326/0003-4819-128-7-199804010-00007, PMID 9518401, S2CID 34734585.
20. ^ Printz LA (April 1992), "Terminal dehydration, a compassionate treatment", Archives of Internal Medicine, 152 (4): 697–700, doi:10.1001/archinte.152.4.697, PMID 1373053.
21. ^ Sullivan RJ (April 1993), "Accepting death without artificial nutrition or hydration", Journal of General Internal Medicine, 8 (4): 220–4, doi:10.1007/BF02599271, PMID 8515334, S2CID 34435654.
22. ^ R. Pool (2004), "You're not going to dehydrate mom, are you?: Euthanasia, versterving, and good death in the Netherlands", Social Science & Medicine, 58 (5): 955–966, doi:10.1016/j.socscimed.2003.10.039, PMID 14732608, S2CID 3161929
23. ^ a b Weyers, Helena Alfonsa Maria (2002). Euthanasie: Het proces van rechtsverandering [Euthanasia: The process of change of law] (Thesis) (in Dutch). University of Groningen.

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