My father is a terminally ill hospice patient, who has esophageal cancer. I and his wife (my mother) want him hydrated and I want to know, from those who are medically knowledgeable, what a good level of hydration would be for him.
posted by parrot_person to science & nature (12 answers total) 3 users marked this as a favorite
My father is a terminally ill hospice patient, who has esophageal cancer. I and his wife (my mother) want him hydrated and I want to know, from those who are medically knowledgeable, what a good level of hydration would be for him that would result in him not being dehydrated to death, yet also not being over-hydrated such that it causes edema or fluid in the "third space", heart failure, etc.
If interested in responding, PLEASE have the respect not to go for the "don't hydrate at all" angle often argued by hospice. I need to use my very limited internet time to read answers to the actual question posed, and I need not to be stressed out by more people insisting that my father be dehydrated to death, to which I could not be more morally opposed.
I'll try to give the necessary information, but if there is something important I've forgotten please ask.
He is 80 years old, probably about 5'8", maybe 150 pounds? Has been bedridden at home in hospice for a little over a week, and was in a nursing home for a little over a week before that while I moved cross-country to be with my parents (because my mom could not handle him at home at that point without me). He has not eaten for probably 2 weeks anything substantial, due to mechanical blockage. His nausea is under pretty good control with applications of anti-nausea cream, so he's not losing fluids that way. During his time in the nursing home, he was taking some fluids by mouth, uncertain how much but certainly not enough. When he was home at first he did not take fluids by mouth, but in the last few days has eaten a few popsicles and drank small amounts of water/juice/milk. He also didn't have the IV fluids for the first few days, as we had to push heavily for them. He is producing urine but it is very dark.
My father himself is in and out of mental clarity, but has always said he wants to be hydrated.
When he was finally prescribed fluids by the medical director of hospice, it was only 30 mL/hour, which translates to 3 cups of water per day. This sounds excruciatingly low to me.
The medical director visited today to assess him and refused to increased the hydration amount--not because there were any signs of edema, heart failure, etc but because of what theoretically "could" happen if he is over-hydrated. He and the hospice nurses have repeatedly mentioned that over-hydrating can cause problems in "many" patients, but there has never been any indication that they have any reason to believe that my father in particular needs such an incredibly low level of hydration to avoid these problems.
In fact, some of the reasons often given for not hydrating don't apply to him (for example, he already had a Groschon, so didn't need a hospital trip or any extra discomfort to put the line in; also there is no indication that his organs are "shutting down", he has good urine output based on the fluids given, etc).
My first question, actually, is can a man of his size and age even maintain life on 3 cups of water a day? What is the minimal amount of fluid he needs not to dehydrate to death? I have posed this question to a hospice nurse who very disrespectfully danced around my question entirely.
I have been Googling trying to determine how much fluid he should really get and am not able to come up with specific figures, other than to say that one study that hydrated at 1000 mL/day improved mental status much more than placebo.
I am morally opposed to starving someone to death as well (to the point that I lost friends over their opinions about the Terry Schiavo case), but I am probably going to lose that battle, as Medicare rules for hospice do not allow TPN and my mother (his wife, and his POA) wants him to stay in hospice and is opposed to TPN (mainly, it seems, for practical reasons such as she does not want him to produce additional feces). If it were up to me, I would probably move him to Home Health Care.
If there's any doubt: YES, I understand that he is dying, but if he dies not naturally but of hospice-forced dehydration, it will compound my grief with a tremendous amount of guilt.