Medical experts are challenging the misconception that fasting leads to a peaceful end of life, warning that deliberately withholding food and water can accelerate death rather than facilitate a “natural” passing. Shao-Yi Cheng, President of the Taiwan Association for Palliative Medicine, emphasizes that palliative care must be guided by scientific evidence rather than personal emotion.
The Risks of Fasting in Terminal Care
Terminal patients typically experience a decline in appetite and severe dry mouth as their bodies begin to fail and metabolic speeds slow. Cheng notes that these patients cannot maintain a standard three-meal-a-day schedule.
Without adequate hydration, patients are prone to electrolyte imbalances caused by dehydration. This can lead to severe symptoms, including limb twitching, general weakness, delirium, and increased mental confusion.
Hydration as a Tool for Comfort
The administration of intravenous (IV) fluids in terminal stages is often misunderstood. Cheng clarifies that the goal of providing a single bottle of IV fluids per day is not to prolong the patient’s life, but to reduce suffering and improve their overall experience.
This approach focuses on improving the patient’s comfort levels. When patients express a desire to eat, medical teams and families are encouraged to assist them to ensure their nutritional and hydration needs are met for the sake of comfort.
Cultural Pressures and Ethical Dilemmas
Physicians frequently face dilemmas when families ask about IV fluids as a patient’s appetite wanes. Because of the local culture, withholding fluids can be perceived by families as abandoning the patient, potentially leading to confrontations with medical staff.
Currently, there is no universal consensus among doctors on how to handle these ethical conflicts, leading to inconsistent practices across different medical providers.
Defending Dignity in the Final Stage
Chiu Chih-Ling, Honorary President of the Taiwan Association for Palliative Nursing, stresses that the core of palliative care is protecting a peaceful, dignified, and natural process. She asserts that whereas patients should not be forced to eat, they must never be deliberately forbidden from doing so.
Chiu cites a case involving a man in his 90s with heart failure who struggled with shortness of breath and choking. By implementing precise swallowing assessments and oral care, the nursing team helped the patient eat according to his own wishes, countering misinformation that had led his family to question if he should continue eating.
Frequently Asked Questions
Does fasting assist a terminal patient achieve a “good death”?
No. According to Shao-Yi Cheng, fasting only accelerates death and is no longer considered a “natural death”; it does not bring about a “good death.”
What is the primary purpose of providing IV fluids to terminal patients?
The purpose is to reduce the patient’s pain and improve their comfort and feelings, rather than to extend their life.
How should medical teams handle patients who have difficulty eating?
Teams should use professional interventions, such as precise swallowing assessments and oral care, to allow patients to eat based on their own will without forcing them.
How can society better balance traditional cultural beliefs with scientific evidence when planning for end-of-life care?
