Starvation, Dehydration & the Physiology of Death

21 thoughts on “Starvation, Dehydration & the Physiology of Death”

  1. Excellent article. I have been in hospice for 25 yrs and palliative care for 5 yrs. This is the first time the concept of dehydration and starvation have been clearly outlined.
    Thank you.

  2. Wonderful article. A lot of what you wrote I knew from 25+ years of Oncology, Palliative Care and Hospice, but I didn’t have sources. It is great to have research backed information to share with my more skeptical colleagues.
    I followed a link from HPNA SmartBrief

  3. Please add me to your email list. I am a new hospice nurse. I appreciate your shared knowledge.

  4. I see a couple of problems with this article, one relatively minor, the other very serious:
    1. CO2 decreases when one’s respiratory rate increases (hyperventilation); it does not increase as you have written.
    2. you have not mentioned the very common problem of “terminal agitation.” People who are dying, with or without dehydration, frequently become delirious/agitated. This has the appearance of being a very unpleasant state for the person going through it. I suspect the subjective nature of it is the same, release of endorphins and various pituitary hormones notwithstanding. -Guy Micco, MD, hospice/palliative care physician

    1. Thank you for your comment. As you know, hyperventilation occurs in response to increased co2 in an attempt to correct the levels. In an irreversible state of dehydration in the actively dying phase Co2 levels remain high and do not resolve. It is the endorphin burst which finally decreases the respiratory rate and causes complete respiratory arrest.

      Of course, there is terminal restlessness, but not by all people. In fact, in my many years of experience working exclusively with the dying, most people have peaceful and uneventful deaths. I would suggest that terminal agitation is often a result of death anxiety, demoralization, guilt, denial and existential angst. These are the sources of true suffering. I am certain terminal suffering/restlessness will be a topic for another blog.

      In my 27 years I have only had to provide palliative sedation to 5 patients and each one was a result of existential issues. Three of them were atheists, one had abandoned her children and one was a Christian pastor.

      Again, thank you for writing.

  5. Wonderful explanations and teaching, that compliment a formal reviews I am doing on the new VSED book. Impressive detail and it all makes sense. Hats off to a Connecticut scholar.

  6. I think the problem with the Terri Schiavo situation was that, she was not dying until they removed her artificial nutrition and hydration. I think that is an important distinction from allowing people to stop eating and drinking naturally because their body is dying and cannot physiologically handle food/drink. I think she did suffer, unfortunately. Her body was not shutting down until they made it shut down.

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