Oxygen, Morphine and Air Hunger

QUESTION: What do you think of use of oxygen at the end of life? – Does it hasten or prolong death?

I consider use of oxygen at end of life a possible comfort measure. In most situations it does not prolong life and it is even questionable if it can ease the “air hunger” that is part of the dying process.

In the days to hours before death when our body is shutting down the heart is unable to pump the blood normally through the body. Circulation is slowed, breathing is slowed, so oxygen exchange between the lungs and the blood is slowed. Nothing in the body is working right, oxygen is not getting where it should throughout the body. Giving extra oxygen may or may not increase the amount of oxygen reaching the organs and cells. It is really questionable as to how much oxygen will be received and utilized but I don’t see a down side to trying to increase the oxygen levels. It will not prolong the dying process, it will not shorten the dying process but it may bring a little more comfort to the physical body.

What we have learned that seems to be more helpful than administering oxygen is to give a small amount (the operative word here is “small”) of Morphine. The Morphine can actually bring comfort from “air hunger” at end of life. It slows down the number of times a person breaths in and out.

In the days to hours before death we need to remember that the “labor” to leave this world is harder on us the watchers than it is on the person dying. Think of the chick working laboriously to get out of its shell, to free itself of the cumbersome shell that contains it. That is what is happening as we watch someone exiting this world. The body is shutting down, nothing works as it normally did, nothing feels as it normally would, there are no normal physical sensations or responses.

Most of the time the person is doing exactly what they are suppose to do when dying. It is we, the watchers, who don’t know what that normal process is. We are the ones who are scared about what is happening. We want the process to stop, to be like it is in the movies--no agitation, no uncomfortable sounds, no smells, just say a few memorable words and close your eyes. Unfortunately, that isn’t how our final act of living unfolds.

In most situations Mom is doing exactly what she is suppose to do to get out of her body. Nothing bad or pathological is happening. It is very sad being with someone we care about when they are dying. Understanding the normal happenings as death approaches neutralizes the fear we bring to the experience. Knowledge reduces fear.

Something more...

My mother used oxygen in last few weeks of her life. She had cancer of the lungs. I have a vivid memory of taking Mother to the mall, oxygen tank in tow, in the final weeks of her life. That story, along with a detailed chapter on multiple tools to help with approaching death are in The Final Act of Living.

18 comments

barbara

Hi Ann, about your comment of your mother’s difficulty breathing during the time before she died: think about how a little chick works to get out of its shell, that is what we are doing as we work to get out of our bodies.  For us the watchers it is frightening but know that what your mother was doing is part of the labor, the work, to leave. With or without the oxygen she would have worked to be free of her heavy, non-functioning body.Thank you for reaching out to me. I hope this has offered some comfort. Blessings! Barbara

Ann

Thank you very much for your post .It has helped me a lot . I am feeling so guilty that I had failed my mother when she died 2 days ago by keeping her oxygen on and prolonging her last hours . It was such hard work for her using the accessory muscles to breathe . Everything had gone well up until those last 12 hours . I feel I failed her by her having to struggle to the very end , exactly what I hoped it would not be .

barbara

Hi Kate, you are right, there is no right or wrong decision. The results of some decisions may be more challenging than others but isn’t that how life works? My hope is that decisions made are based on knowledge gained and information considered.
My blessings to you and your mom. Barbara

Kate

Thank you for posting this useful information. My 97-year-old mother is on her end-of-life journey. It is hard not to feel guilty and/or confused about these decisions about oxygen (life support that prolongs agony or palliative assistance?) and morphine (a pain reliever or expediter?). In previous centuries, we did not have much information and no hospice care (people just died). Now, we are blessed with amazing resources (assisted living, memory care, palliative care, hospice). And, yet, even with amazing resources it is no easy task to hold incredible respect for the family member and care givers and hospice workers, and doctors, while at the same time wonder if I, as the decision maker, am doing the “right thing.” Your post is something very comforting to me. My take away is that “there is no right or wrong thing,” and that my mom is very fortunate to be in such a peaceful and natural place doing her own thing.

Barbara

Hi Sylvia, If the oxygen is causing more discomfort and agitation then benefit, discontinue it. Seems contrary to keeping him comfortable if it is causing him to be more agitated. Giving him a small amount of morphine is probably easing his respiratory distress as much, if not more, than the oxygen is. Blessings! Barbara

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