Dear Barbara, Could you address the use of oxygen as a comfort measure? I don’t mean as a result of measuring the SATs, but as a source of comfort to the patient.
There is research saying that administering oxygen as the end of life approaches doesn’t prolong life or even have any beneficial effects. It states that the physical body is so compromised due to decreased circulation and lung congestion that there is no effect. The body is shutting down, nothing works right, so it can’t process the oxygen that is being pushed into it.
My opinion? We need to ask why we are thinking about giving the oxygen. Is it because the person looks like they are having difficulty breathing? Well, as death approaches a person has difficulty breathing. There is congestion (depending upon how hydrated or dehydrated they are). There are the mouth movements that look labored, restlessness. Often there are sounds as breath goes in and out of the mouth. These are part of the normal way a body dies. Remember “nothing works right, everything is shutting down”. We are watching a “chick getting out of its shell”. There is labor involved in getting out of our body.
For us it is very difficult to see our loved one struggling. Most of us are at the bedside of someone who is dying because we are emotionally involved. We are watching with our hearts and emotions, not our intellect, our minds. When we have knowledge of the dying process, when we can understand that what we are seeing is normal, our mind can tell our heart “nothing bad is happening here. It is sad but nothing bad”.
Now back to oxygen--what do we have to lose by administering oxygen as end of life approaches? A few dollars to set it up and pay for it, and it probably won’t be of any help in easing the breathing challenges. Basically that is the downside. The up side is MAYBE it will bring a bit of ease to the patient and for sure it will bring comfort to the watchers. The watchers will feel they are doing something and that they tried to make their loved one more comfortable.
End of life work is not about just taking care of the patient. It is about caring for the family and significant others as well. Oxygen at the end of life can be considered a comfort measure for the family.
Something More about Oxygen at End of Life: In my book The Eleventh Hour, the companion book to Gone From My Sight, I go over the use of oxygen in the final days of life. There is special care for the mouth that needs to be given when oxygen is used which is outlined in the book.
16 comments
barbara
Hi Faye, COPD is a horrific disease. My heart goes out to anyone suffering with it. About your brother; I do not have enough information about his medical history to comment on his treatment. I can say that I m puzzled by the comment he was receiving so much oxygen he couldn’t get it at home. To my knowledge when a concentrator can’t provide enough oxygen, home equipment companies can bring in tanks of oxygen and, although it will use up more rapidly, can supply whatever quantity is needed. I don’t see why he had to be in the hospital unless there was another reason. He could also go to a rehab or nursing facility and receive the same oxygen concentration as a hospital—so that doesn’t make sense to me.
Was your brother euthanized by the lowering of the oxygen and use of morphine. I just don’t have enough information to know. You can always make an appointment with the attending physician and ask your questions, express your concerns, and see what the answer is.
May blessings are with you. Barbara
Hi Faye, COPD is a horrific disease. My heart goes out to anyone suffering with it. About your brother; I do not have enough information about his medical history to comment on his treatment. I can say that I m puzzled by the comment he was receiving so much oxygen he couldn’t get it at home. To my knowledge when a concentrator can’t provide enough oxygen, home equipment companies can bring in tanks of oxygen and, although it will use up more rapidly, can supply whatever quantity is needed. I don’t see why he had to be in the hospital unless there was another reason. He could also go to a rehab or nursing facility and receive the same oxygen concentration as a hospital—so that doesn’t make sense to me.
Was your brother euthanized by the lowering of the oxygen and use of morphine. I just don’t have enough information to know. You can always make an appointment with the attending physician and ask your questions, express your concerns, and see what the answer is.
May blessings are with you. Barbara
Faye
My brother in law suffered from COPD and was tethered to oxygen for years. His mind was extremely alert until death. In his last days, his body required higher oxygen levels than the home oxygenator could supply so he was transported to the hospital. The doctor decided to reduce the oxygen rate, Joe was given morphine and was dead within hours. I often wonder if this was euthanasia. He would have had to live the rest of his life in the hospital to get enough oxygen but neither he nor his family was given the option to choose. In my head, I know he had a limited time left but in my heart, it was cruel to hear and see the doctor turn his oxygen supply down. This was done to speed his death. Again he was awake, talking, and alert when the doctor made that judgement without consulting his family. He was not in a vegetative state or coma. Just seems like euthanasia to me.
My brother in law suffered from COPD and was tethered to oxygen for years. His mind was extremely alert until death. In his last days, his body required higher oxygen levels than the home oxygenator could supply so he was transported to the hospital. The doctor decided to reduce the oxygen rate, Joe was given morphine and was dead within hours. I often wonder if this was euthanasia. He would have had to live the rest of his life in the hospital to get enough oxygen but neither he nor his family was given the option to choose. In my head, I know he had a limited time left but in my heart, it was cruel to hear and see the doctor turn his oxygen supply down. This was done to speed his death. Again he was awake, talking, and alert when the doctor made that judgement without consulting his family. He was not in a vegetative state or coma. Just seems like euthanasia to me.
Barbara
Hi Mary, in response to your question, was your father dead when you turned off the oxygen. Yes, he probably was (but even if he wasn’t, turning off the oxygen at that point would not have affected the time of his death). It appears to me he wanted you to be with him when he left. He waited for you to arrive and died after everyone else left. He gave you a beautiful gift. Blessings! Barbara
Hi Mary, in response to your question, was your father dead when you turned off the oxygen. Yes, he probably was (but even if he wasn’t, turning off the oxygen at that point would not have affected the time of his death). It appears to me he wanted you to be with him when he left. He waited for you to arrive and died after everyone else left. He gave you a beautiful gift. Blessings! Barbara
Mary Friedman
My dad was in a nursing home. He was dying. I got to his nursing home where he was surrounded by family. He told them he was waiting for me before he went unconscious. He squeezed my hand. He was on oxygen (tube in his nose). After a few hours family left for dinner. I watched his artery in his neck go up and down. I felt he was gone. I shut off oxygen and the artery was still. Does this mean he was already gone.
My dad was in a nursing home. He was dying. I got to his nursing home where he was surrounded by family. He told them he was waiting for me before he went unconscious. He squeezed my hand. He was on oxygen (tube in his nose). After a few hours family left for dinner. I watched his artery in his neck go up and down. I felt he was gone. I shut off oxygen and the artery was still. Does this mean he was already gone.
Barbara
Hi Clifford, I don’t have enough medical information about your mother to comment on what occurred. I am sorry you had to leave the hospital and that no one paid attention to your concerns. You obviously had your mother’s comfort as your priority. You might write your mother a letter and put your concerns and what you were trying to do for her on paper. Tell her everything in your heart and mind. No one needs to know about the letter. When you are finished burn the letter and scatter the ashes to the wind letting go of all the frustration that went into those last days with your family. Know that your mom will know what is in your heart. My blessings are with you and your family. Barbara
Hi Clifford, I don’t have enough medical information about your mother to comment on what occurred. I am sorry you had to leave the hospital and that no one paid attention to your concerns. You obviously had your mother’s comfort as your priority. You might write your mother a letter and put your concerns and what you were trying to do for her on paper. Tell her everything in your heart and mind. No one needs to know about the letter. When you are finished burn the letter and scatter the ashes to the wind letting go of all the frustration that went into those last days with your family. Know that your mom will know what is in your heart. My blessings are with you and your family. Barbara
Clifford
My mom has passed. During this process I noticed 2 things: 1) She had no problem taking in oxygen through just her nose. Her O2 in her blood remained in the 90’s. 2) The nurse decided to “help her breath better, through her mouth”, and put a mask on. Quickly I, but not the rest of my family, noticed her chest immediately rising with each breath. I asked myself why and then outside the room I asked the nurse. I asked her why she did that, bc it was obvious to me my Mom was laboring much more to breath. The nurse gave me an answer I fought, tried to explain to my family what I witnessed, and I asked then to see the Doctor on the floor. He seemed to agree with me, but when my father forced me out of the hospital I found out from my sister that the mask was never taken off; i.e. the nose tube was never put back on. (The nurse explained to me, despite me witnessing the difference in my Mom’s comfort, that she, the nurse, thought it best to keep the mask on. That’s when I asked to talk with the Doctor to get his opinion. He seemed to agree with me, even seemed to gesture to me by nodding his head that the tube in the nose would be used, but when I left the hospital no changes were made. It’s very a aggravating.) I have been working as a Personal Care Worker for 10 years. My sister, a retired veterinarian technician. And my brother, a soon-to-be retired assistant manager of a Home Depot. My father, 90. And my Mom, 87.
My mom has passed. During this process I noticed 2 things: 1) She had no problem taking in oxygen through just her nose. Her O2 in her blood remained in the 90’s. 2) The nurse decided to “help her breath better, through her mouth”, and put a mask on. Quickly I, but not the rest of my family, noticed her chest immediately rising with each breath. I asked myself why and then outside the room I asked the nurse. I asked her why she did that, bc it was obvious to me my Mom was laboring much more to breath. The nurse gave me an answer I fought, tried to explain to my family what I witnessed, and I asked then to see the Doctor on the floor. He seemed to agree with me, but when my father forced me out of the hospital I found out from my sister that the mask was never taken off; i.e. the nose tube was never put back on. (The nurse explained to me, despite me witnessing the difference in my Mom’s comfort, that she, the nurse, thought it best to keep the mask on. That’s when I asked to talk with the Doctor to get his opinion. He seemed to agree with me, even seemed to gesture to me by nodding his head that the tube in the nose would be used, but when I left the hospital no changes were made. It’s very a aggravating.) I have been working as a Personal Care Worker for 10 years. My sister, a retired veterinarian technician. And my brother, a soon-to-be retired assistant manager of a Home Depot. My father, 90. And my Mom, 87.
Enrique A. Cordro
I have to agree with the consensus that oxygen, at the end of life, will not have much of an impact. However, we do not know with absolute certainty that it will not have some benefit, however small that may be, if only to enhance some degree of oxygenation to the brain and other tissues. Most importantly, if providing oxygen provides a sense of having done something for your loved one then it is worthwhile. My mother was at home with hospice and she never required supplemental oxygen. Her saturation always remained in the 90’s until the very end. The process of dying is an individual process even though there are many aspects that are common. How that process manifests itself will vary according to many factors including the underlying disease processes that led to the end of life as well as mental, emotional, spiritual, and other socio-cultural aspects of that individual. Lastly, provide the dying with the best possible death and as much comfort to the grieving family as possible.
I have to agree with the consensus that oxygen, at the end of life, will not have much of an impact. However, we do not know with absolute certainty that it will not have some benefit, however small that may be, if only to enhance some degree of oxygenation to the brain and other tissues. Most importantly, if providing oxygen provides a sense of having done something for your loved one then it is worthwhile. My mother was at home with hospice and she never required supplemental oxygen. Her saturation always remained in the 90’s until the very end. The process of dying is an individual process even though there are many aspects that are common. How that process manifests itself will vary according to many factors including the underlying disease processes that led to the end of life as well as mental, emotional, spiritual, and other socio-cultural aspects of that individual. Lastly, provide the dying with the best possible death and as much comfort to the grieving family as possible.
Maureen Asper
ForJayne Reed – I was a hospice and palliative nurse and am now caring for my husband full time as he slowly leaves this life. I don’t believe any nurse would deliberately kink any tubes. I know that with our oxygen concemtrator, it will often kink where it enters the machine due to gravity pulling it down. It happened so much that I placed an ottoman next to it to lay the tubing on so it doesn’t go straight down from where it hooks into the machine. As hospice nurses we usually view oxygen as a comfort measure that may not be necessary at the end, but doesn’t do any harm so no problem to leave it on if desired. As a side note, my husband never noticed the kinks. It just bothered me so I do everything I can to make sure it is not linked there or anywhere else along his 50’ tube.
ForJayne Reed – I was a hospice and palliative nurse and am now caring for my husband full time as he slowly leaves this life. I don’t believe any nurse would deliberately kink any tubes. I know that with our oxygen concemtrator, it will often kink where it enters the machine due to gravity pulling it down. It happened so much that I placed an ottoman next to it to lay the tubing on so it doesn’t go straight down from where it hooks into the machine. As hospice nurses we usually view oxygen as a comfort measure that may not be necessary at the end, but doesn’t do any harm so no problem to leave it on if desired. As a side note, my husband never noticed the kinks. It just bothered me so I do everything I can to make sure it is not linked there or anywhere else along his 50’ tube.
Rena
Barbara I am a retired nurse and have been with many people who were dying;
Family, friends and patients.
When I am at the end of my life please have oxygen available for me as I do not want to be gasping for my last breath and struggling to breathe.
I don’t want to be hooked up to a bunch of tubes and IV fluids, tube feedings, ventilators etc. but I do want to be able to breathe in comfort.
My family and friends do not need to feel guilty and uncomfortable being around me because I cannot get my breath and am struggling to breathe.
I have read all of your books and share them with family and friends and they are so very grateful for them.
Thankyou
Barbara I am a retired nurse and have been with many people who were dying;
Family, friends and patients.
When I am at the end of my life please have oxygen available for me as I do not want to be gasping for my last breath and struggling to breathe.
I don’t want to be hooked up to a bunch of tubes and IV fluids, tube feedings, ventilators etc. but I do want to be able to breathe in comfort.
My family and friends do not need to feel guilty and uncomfortable being around me because I cannot get my breath and am struggling to breathe.
I have read all of your books and share them with family and friends and they are so very grateful for them.
Thankyou
Jayne Reed
My mother always said she didn’t want to be kept alive by machines, but she also said, “Don’t take away my oxygen!”
In her last hour, i tried to take off the tubes so she would look more glamorous on her deathbed (she had a vain streak), but she struggled, so I put the tubes back in and she settled down.
After the funeral home came for her, I was undoing all the equipped so the guys could take it away the next morning, and I noticed what looked like a deliberate kink in the tubing near the compressor, which I guess the hospice nurse put there. So Mom wasn’t getting any oxygen, but she thought she was…
My mother always said she didn’t want to be kept alive by machines, but she also said, “Don’t take away my oxygen!”
In her last hour, i tried to take off the tubes so she would look more glamorous on her deathbed (she had a vain streak), but she struggled, so I put the tubes back in and she settled down.
After the funeral home came for her, I was undoing all the equipped so the guys could take it away the next morning, and I noticed what looked like a deliberate kink in the tubing near the compressor, which I guess the hospice nurse put there. So Mom wasn’t getting any oxygen, but she thought she was…
Mary
As an RN working on an inpatient hospice unit for 18 years, I cared for many patients receiving oxygen. Oxygen was often started routinely in the ambulance on the way to the hospital. After many days/weeks in the hospital, it was simply part of their care.
We would assess the need for it when they arrived on our unit. Not necessarily by 02 sats, but by how the patient looked and felt with or without it. Often during a bath, we would remove it while washing the patient’s face. If there was no change in respirations or evidence of distress, we would continue the bath keeping a close eye on their respiratory needs. Quite often, they remained comfortable. When the family would return, we would let them know what we did and they were often grateful not to have to look at that cannula on their loved one’s face. To allow a natural death without unnecessary tubes is a blessing to many. To others, they need to see that we are ‘treating’ the patient to the end. It is a very individualized choice and always should be based on the needs of the patient and family.
As an RN working on an inpatient hospice unit for 18 years, I cared for many patients receiving oxygen. Oxygen was often started routinely in the ambulance on the way to the hospital. After many days/weeks in the hospital, it was simply part of their care.
We would assess the need for it when they arrived on our unit. Not necessarily by 02 sats, but by how the patient looked and felt with or without it. Often during a bath, we would remove it while washing the patient’s face. If there was no change in respirations or evidence of distress, we would continue the bath keeping a close eye on their respiratory needs. Quite often, they remained comfortable. When the family would return, we would let them know what we did and they were often grateful not to have to look at that cannula on their loved one’s face. To allow a natural death without unnecessary tubes is a blessing to many. To others, they need to see that we are ‘treating’ the patient to the end. It is a very individualized choice and always should be based on the needs of the patient and family.
Mary Lou Wilson
I was doing a visit with hospice patient who was unresponsive and close to death. He was also using nasal oxygen. During this visit his wife asked me if she could take the oxygen off as it may be prolonging his life. I said yes, she removed it, and within 10 minutes, his face became bluish and he passed.
I was doing a visit with hospice patient who was unresponsive and close to death. He was also using nasal oxygen. During this visit his wife asked me if she could take the oxygen off as it may be prolonging his life. I said yes, she removed it, and within 10 minutes, his face became bluish and he passed.
Heather Arps
Thanks for your insights Barbara. I have worked in hospice in the home setting for over 30 years and find that like some much else at end of life it’s more about the choice to use O2 or not. I’ve had clients who simply need to be able to decide something for themselves amidst all the loss of control as they die. I’ve had people who are no fuss and choose to not use it and I’ve seen situations where it is clearly used to soothe the family.
Thank you again for your clear, compassionate view.
Thanks for your insights Barbara. I have worked in hospice in the home setting for over 30 years and find that like some much else at end of life it’s more about the choice to use O2 or not. I’ve had clients who simply need to be able to decide something for themselves amidst all the loss of control as they die. I’ve had people who are no fuss and choose to not use it and I’ve seen situations where it is clearly used to soothe the family.
Thank you again for your clear, compassionate view.
Jerry Pesses, Chaplain
Caring for the family is equally import to that of the patient. In our world the patient and the family is one unit. I agree that giving Oxygen is a small price to pay for peace of mind. I find that we touch on this all the time. We use your books as gospel. Thanks for your continuous effort in writing these books.
Jerry
Caring for the family is equally import to that of the patient. In our world the patient and the family is one unit. I agree that giving Oxygen is a small price to pay for peace of mind. I find that we touch on this all the time. We use your books as gospel. Thanks for your continuous effort in writing these books.
Jerry
Marti
I am a retired nurse who has worked on a palliative care unit and can say; whether it be for the comfort of the patient or the family or both prn oxygen should ALWAYS be available. I am old if I am dying please give me oxygen whether I need it or not I WANT it. I am dying and it isn’t going to hurt me. Research be damned.
I am a retired nurse who has worked on a palliative care unit and can say; whether it be for the comfort of the patient or the family or both prn oxygen should ALWAYS be available. I am old if I am dying please give me oxygen whether I need it or not I WANT it. I am dying and it isn’t going to hurt me. Research be damned.
Lisa ONeill
My hospice care nurse said there are two reasons for the oxygen. It might make my husband more comfortable and it will keep his skin color normal. She said without oxygen he would have turned a bluish purple color and that it was distressing to witness so it was also to comfort the caregivers witnessing the death.
My hospice care nurse said there are two reasons for the oxygen. It might make my husband more comfortable and it will keep his skin color normal. She said without oxygen he would have turned a bluish purple color and that it was distressing to witness so it was also to comfort the caregivers witnessing the death.