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.
23 comments
Melissa
Thank you for this post as I lost my grandmother on 1/28/24..I was in the room with other family members when she passed..The hospital placed her on oxygen and nothing else per her request..she said she wanted to go peacefully,but from what I saw I don’t feel like it was and it’s riddled me with guilt ..After they removed the nasal oxygen she passed away with ten minutes…did the oxygen prolong her death or was she just waiting for us all to there in the morning…Her labored breathing even with the oxygen was nothing I’ve seen before or would want to again…I like to think she heard me when I talked to her about the beach and said I love you but she didn’t even respond…I am so hea I didn’t get one last goodbye she’s been to the hospital numerous times, mom said let her rest tonight so I did…. got a call at six am to come now…drive an hour and saw her again not like the beautiful lady I knew…it was scary even say traumatic…bless you for all you do…..
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BK Books replied:
Hi Melissa, to answer your questions: I don’t think the oxygen was keeping your grandmother alive. I think she was waiting for you all to be with her. I do believe she could hear you but as if in a dream. The labored breathing was just part of the struggle to get out of her body. You might write her a letter. Say all the things you still need and want to say to her. Burn the letter and scatter the ashes to the wind. Let how well you live your life be the gift of love that you give her. Blessings to you and your family. Barbara
Thank you for this post as I lost my grandmother on 1/28/24..I was in the room with other family members when she passed..The hospital placed her on oxygen and nothing else per her request..she said she wanted to go peacefully,but from what I saw I don’t feel like it was and it’s riddled me with guilt ..After they removed the nasal oxygen she passed away with ten minutes…did the oxygen prolong her death or was she just waiting for us all to there in the morning…Her labored breathing even with the oxygen was nothing I’ve seen before or would want to again…I like to think she heard me when I talked to her about the beach and said I love you but she didn’t even respond…I am so hea I didn’t get one last goodbye she’s been to the hospital numerous times, mom said let her rest tonight so I did…. got a call at six am to come now…drive an hour and saw her again not like the beautiful lady I knew…it was scary even say traumatic…bless you for all you do…..
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BK Books replied:
Hi Melissa, to answer your questions: I don’t think the oxygen was keeping your grandmother alive. I think she was waiting for you all to be with her. I do believe she could hear you but as if in a dream. The labored breathing was just part of the struggle to get out of her body. You might write her a letter. Say all the things you still need and want to say to her. Burn the letter and scatter the ashes to the wind. Let how well you live your life be the gift of love that you give her. Blessings to you and your family. Barbara
Davis
Hi Barbara,
My Mother passed on Friday afternoon a few hours after our email exchange. I am trying to regain my footing but I am struggling. I know having some answers would help and hopefully help others who are reading this and going through something this difficult.
I have two questions please, if you would help.
1. My Mothers eyes turned from hazel (her original eye color) to ice blue to gray. This happen within the last 24 hour of her life and was very frightening. Do you know anything about this? I think it would be beneficial for others to know of this and why it happens.
2. When my Mother was struggling (fighting) at the end the oxi pulse displayed no numbers. The hospice nurse said ’She’s gone.’ However, my Mother still ‘breathed’ these abrupt, jolted exhales for about 30 minutes and then these stopped. I want to know, please, did she die when the nurse said ’She’s gone.’ or when the last breathe was exhaled? I know this might seem insignificant but it does matter to me. And, if this type of breathing is a residual type of thing, I think others would benefit from knowing this as well.
Thank you for sharing your expertise.
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BK Books replied:
Davis, about your two questions: your mom’s eye color changing I have not noticed before. Most eyelids are at “half mast”, or one eye partially open, the other closed, so I didn’t see a lot of really open eyes and no one asked me about a color change. That said doesn’t mean it hasn’t happened to others. As the energy leaves the body there are so many unexplained changes. The continued breathing after the oxy meter displayed no numbers: most often there will be no readings from the blood pressure cuff and you can’t get a pulse reading by machine or by hand. Yet the heart is still beating, getting slower and slower and breathing getting longer and longer between breaths. Not getting a reading to me doesn’t mean she was dead. It tells me she was very close but as long as she was taking occasional breaths I personally think she had not finished her labor. All that said I have had, after a person was presumed dead (no heartbeat, no breaths) make sounds, gurgling, even gasps. It is just air or fluids releasing from the body. LIfe is gone, just the shell reacting to gravity and external movement. I hope this eases your mind as to how your mother died. You might write her a letter, put your thoughts and concerns, tell her everything that is in your heart. Burn the letter and scatter the ashes to the wind. Let how well you live your life be the gift of love you give her. Blessings! Barbara
Hi Barbara,
My Mother passed on Friday afternoon a few hours after our email exchange. I am trying to regain my footing but I am struggling. I know having some answers would help and hopefully help others who are reading this and going through something this difficult.
I have two questions please, if you would help.
1. My Mothers eyes turned from hazel (her original eye color) to ice blue to gray. This happen within the last 24 hour of her life and was very frightening. Do you know anything about this? I think it would be beneficial for others to know of this and why it happens.
2. When my Mother was struggling (fighting) at the end the oxi pulse displayed no numbers. The hospice nurse said ’She’s gone.’ However, my Mother still ‘breathed’ these abrupt, jolted exhales for about 30 minutes and then these stopped. I want to know, please, did she die when the nurse said ’She’s gone.’ or when the last breathe was exhaled? I know this might seem insignificant but it does matter to me. And, if this type of breathing is a residual type of thing, I think others would benefit from knowing this as well.
Thank you for sharing your expertise.
———
BK Books replied:
Davis, about your two questions: your mom’s eye color changing I have not noticed before. Most eyelids are at “half mast”, or one eye partially open, the other closed, so I didn’t see a lot of really open eyes and no one asked me about a color change. That said doesn’t mean it hasn’t happened to others. As the energy leaves the body there are so many unexplained changes. The continued breathing after the oxy meter displayed no numbers: most often there will be no readings from the blood pressure cuff and you can’t get a pulse reading by machine or by hand. Yet the heart is still beating, getting slower and slower and breathing getting longer and longer between breaths. Not getting a reading to me doesn’t mean she was dead. It tells me she was very close but as long as she was taking occasional breaths I personally think she had not finished her labor. All that said I have had, after a person was presumed dead (no heartbeat, no breaths) make sounds, gurgling, even gasps. It is just air or fluids releasing from the body. LIfe is gone, just the shell reacting to gravity and external movement. I hope this eases your mind as to how your mother died. You might write her a letter, put your thoughts and concerns, tell her everything that is in your heart. Burn the letter and scatter the ashes to the wind. Let how well you live your life be the gift of love you give her. Blessings! Barbara
Davis
Good Morning Barbara~
I thought I was ready, ‘at peace’ with this. This being my Mother’s passing but I am struggling. I sit next to my Mother as I type this comment. It is Friday, she has been NPO since last Friday, her breathing is labored, put on oxygen this morning, eyes have gone from hazel to ice blue to gray in color, halfed masted. Over the past week I have searched and searched topics regarding the dying process. Searches to gain knowledge to assiting with witnessing this. Your documentation is the most touching and helpful thus far. Especially this: ‘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.’
I am an educator so I am a true advocate of: ‘Knowledge reduces fear.’ ~Especially now
Thank you for propagating knowledge and reducing fear~
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BK Books replied:
Hi Davis, now is the time to talk with your mother (even though she won’t respond she can hear you). Talk about the good times and the challenging times. Tell her how you love her and just hold her hand or even crawl in bed with her and hold her (if that feels like that is what you need to do). This is a special time. My thoughts are with you and your mom. Blessings! Barbara
Good Morning Barbara~
I thought I was ready, ‘at peace’ with this. This being my Mother’s passing but I am struggling. I sit next to my Mother as I type this comment. It is Friday, she has been NPO since last Friday, her breathing is labored, put on oxygen this morning, eyes have gone from hazel to ice blue to gray in color, halfed masted. Over the past week I have searched and searched topics regarding the dying process. Searches to gain knowledge to assiting with witnessing this. Your documentation is the most touching and helpful thus far. Especially this: ‘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.’
I am an educator so I am a true advocate of: ‘Knowledge reduces fear.’ ~Especially now
Thank you for propagating knowledge and reducing fear~
———
BK Books replied:
Hi Davis, now is the time to talk with your mother (even though she won’t respond she can hear you). Talk about the good times and the challenging times. Tell her how you love her and just hold her hand or even crawl in bed with her and hold her (if that feels like that is what you need to do). This is a special time. My thoughts are with you and your mom. Blessings! Barbara
rps
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BK Books replied:
RPS. Giving oxygen as end of life approaches is controversial. Some say it does not prolong life or provide any comfort while others (like me) say “why not use it if family requests. It will bring the family comfort if nothing else”. Blessings! Barbara
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BK Books replied:
RPS. Giving oxygen as end of life approaches is controversial. Some say it does not prolong life or provide any comfort while others (like me) say “why not use it if family requests. It will bring the family comfort if nothing else”. Blessings! Barbara
Lisa Garrett
Thanks for the info. I shared it with my husband Billy so he would know what to expect at the end of my journey. I’m on oxygen all the time seen 2021 I had COVID an if left my lungs in bad shape. Before that I was fully active remodeling my Dad’s houses to sale after I retired. Then came COVID again THANKS
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BK Books replied:
Lisa, my blessings are with you during this challenging time. Barbara
Thanks for the info. I shared it with my husband Billy so he would know what to expect at the end of my journey. I’m on oxygen all the time seen 2021 I had COVID an if left my lungs in bad shape. Before that I was fully active remodeling my Dad’s houses to sale after I retired. Then came COVID again THANKS
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BK Books replied:
Lisa, my blessings are with you during this challenging time. Barbara
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
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 .
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
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.
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
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
Barbara
Hi Irene, from what you have described I think it will be blessing for your mom to sleep through her final days. She has told you she is “ready to go” and is agitated and stressed as her body is shutting down. I see sedating her as giving her a gift from the obvious discomfort she is in. I see no need to discontinue the oxygen. It is a comfort measure while not necessarily extending her dying process.
My blessings are with you both. Barbara
Hi Irene, from what you have described I think it will be blessing for your mom to sleep through her final days. She has told you she is “ready to go” and is agitated and stressed as her body is shutting down. I see sedating her as giving her a gift from the obvious discomfort she is in. I see no need to discontinue the oxygen. It is a comfort measure while not necessarily extending her dying process.
My blessings are with you both. Barbara
Sylvia Golden
Hello, my husband is at home in hospice. 2001 he had a heart transplant. Hospice just started oxygen. Should we continue because he pulls it out of his nose & gets tangled in the cords. I’ve given him a small amt of morphine & adavant every 4 hrs.
So sad to watch.
Look forward to a response.
Thank you,
Sylvia Golden
Hello, my husband is at home in hospice. 2001 he had a heart transplant. Hospice just started oxygen. Should we continue because he pulls it out of his nose & gets tangled in the cords. I’ve given him a small amt of morphine & adavant every 4 hrs.
So sad to watch.
Look forward to a response.
Thank you,
Sylvia Golden
Irene
My 94yo mother lived alone until 4 mos ago and only had O2 at night. She has CHF and pulmonary hypertension. After the fall rehab resulted in extreme edema bc she couldn’t wear the brace and they wouldn’t let her out of bed wo it. She was discharged bc she wasn’t compliant. Days later back into the hospital and they got 15 lbs of fluid off her. We moved her to assisted living. 4 wks later she got pneumonia. Back into the hospital and now is in hospice. Throughout this time we’ve had numerous O2 deprivation events. Combative and harmful to herself and others. She was on morphine but has been refusing it for the last 72 hrs. If left alone she takes the cannula out and then we’re back to the deprivation behavior and she accuses everyone of everything. She has said over and over she’s ready to go. Our question is whether or not it’s right to keep her sedated and take her off O2. Thank you in advance for your response.
My 94yo mother lived alone until 4 mos ago and only had O2 at night. She has CHF and pulmonary hypertension. After the fall rehab resulted in extreme edema bc she couldn’t wear the brace and they wouldn’t let her out of bed wo it. She was discharged bc she wasn’t compliant. Days later back into the hospital and they got 15 lbs of fluid off her. We moved her to assisted living. 4 wks later she got pneumonia. Back into the hospital and now is in hospice. Throughout this time we’ve had numerous O2 deprivation events. Combative and harmful to herself and others. She was on morphine but has been refusing it for the last 72 hrs. If left alone she takes the cannula out and then we’re back to the deprivation behavior and she accuses everyone of everything. She has said over and over she’s ready to go. Our question is whether or not it’s right to keep her sedated and take her off O2. Thank you in advance for your response.
Barbara
Hi Mary, the research on oxygen prolonging life as death approaches is unresolved. Some say yes, some say no.
I, personally, consider oxygen a comfort measure and do not believe it extends life. If it eases the difficulty of breathing then we want to do that particularly if we are talking months to live (which from the description of your mother she does). In the days to hours before death it really doesn’t have much of a benefit even for comfort.
Hope this helps make your decision. Blessings to you and your mother. Barbara
Hi Mary, the research on oxygen prolonging life as death approaches is unresolved. Some say yes, some say no.
I, personally, consider oxygen a comfort measure and do not believe it extends life. If it eases the difficulty of breathing then we want to do that particularly if we are talking months to live (which from the description of your mother she does). In the days to hours before death it really doesn’t have much of a benefit even for comfort.
Hope this helps make your decision. Blessings to you and your mother. Barbara
Mary Griffin
95 year old mother. advanced dementia, otherwise very healthy.
Expressed wishes not to prolong life, DNR, has experienced a full life, ready to go.
Hospice recommended nasal oxygen therapy because low stats.
Only medicine currently prescribed is risperidone.
Is the oxygen prolonging life?
95 year old mother. advanced dementia, otherwise very healthy.
Expressed wishes not to prolong life, DNR, has experienced a full life, ready to go.
Hospice recommended nasal oxygen therapy because low stats.
Only medicine currently prescribed is risperidone.
Is the oxygen prolonging life?
Barbara
Hi Lori, to answer your question I do not think oxygen is prolonging your mother’s life. I agree with your hospice nurse oxygen is a comfort measure. Blessings to you and your family. Barbara
Hi Lori, to answer your question I do not think oxygen is prolonging your mother’s life. I agree with your hospice nurse oxygen is a comfort measure. Blessings to you and your family. Barbara
LORI A PAAPE
Hello my Mom is 82 and has Alzheimer’s, she has been going down hill for the last month I am her POA and she has a active DNR we have Hospice working with us and I would like to know as her POA knowing that she wanted nothing to keep her alive , is the oxygen prolonging her life or not hospice says it’s only for comfort I am second guessing it all the time.
Hello my Mom is 82 and has Alzheimer’s, she has been going down hill for the last month I am her POA and she has a active DNR we have Hospice working with us and I would like to know as her POA knowing that she wanted nothing to keep her alive , is the oxygen prolonging her life or not hospice says it’s only for comfort I am second guessing it all the time.
Barbara
Hi Jennifer, I do not have enough medical information about your grandmother to know about the cause of her “trouble breathing”. I would suggest you call her doctor and ask your questions. Ask “Why is she having trouble breathing and what can we do about it”. Is she on hospice? If not also ask if she is appropriate for hospice care. With a hospice referral you will have some support and guidance as you care for your grandmother. Blessings! Barbara
Hi Jennifer, I do not have enough medical information about your grandmother to know about the cause of her “trouble breathing”. I would suggest you call her doctor and ask your questions. Ask “Why is she having trouble breathing and what can we do about it”. Is she on hospice? If not also ask if she is appropriate for hospice care. With a hospice referral you will have some support and guidance as you care for your grandmother. Blessings! Barbara
Jennifer
My grandmother said she is having trouble breathing. Ismorphine for that. We had to give it to her twice.
My grandmother said she is having trouble breathing. Ismorphine for that. We had to give it to her twice.
Cyoa
Thank you for writing this.
Thank you for writing this.
Martha
You have given a beautiful and compassionate explanation of part of the dying process. What comfort this brings to many. Thank you very much.
Blessings,
Martha
You have given a beautiful and compassionate explanation of part of the dying process. What comfort this brings to many. Thank you very much.
Blessings,
Martha
Barbara Karnes
Hi Diana, hospices often differ in their use of oxygen and morphine. There are federal guidelines to follow but there is a bit of interpretive leeway when we address “comfort measures.” The bigger issue here is will her physician sign the hospice paper stating a six month prognosis.
I have no problem trying oxygen although am not sure it will actually help. Her body is wearing out. I know you want to keep her as comfortable as possible but SOB on activity may not be something you can fix for her. A little bit of morphine for the SOB, it may help or not. Can’t hurt to try and see.
Thank you for reaching out to me. I will keep you and your aunt in my thoughts. Blessings! Barbara
Hi Diana, hospices often differ in their use of oxygen and morphine. There are federal guidelines to follow but there is a bit of interpretive leeway when we address “comfort measures.” The bigger issue here is will her physician sign the hospice paper stating a six month prognosis.
I have no problem trying oxygen although am not sure it will actually help. Her body is wearing out. I know you want to keep her as comfortable as possible but SOB on activity may not be something you can fix for her. A little bit of morphine for the SOB, it may help or not. Can’t hurt to try and see.
Thank you for reaching out to me. I will keep you and your aunt in my thoughts. Blessings! Barbara
Diana Jaycox
I have an 90 year old aunt I am caring for who has CHFand ERSD as part of her chronic complications of Type 2 DM. She has opted to not have dialysis and to seek only comfort care. However, she is bothered by severe SOB with any exertion. Her O2 sats remain above 94% and she does not meet Medicare guidelines for O2 use. I am trying to help her deal with the frustration of taking longer to do simple tasks due to need for energy conservation. As a RN I understand her SOB is related to her chronic anemia and fluid overload. I understand that oxygen may not really help. My question is if she was a hospice patient, could I get her oxygen as a comfort measure as well,, as anxiety and morphine for comfort, as her current MD States she does not meet Medicare guidelines for these now.
I have an 90 year old aunt I am caring for who has CHFand ERSD as part of her chronic complications of Type 2 DM. She has opted to not have dialysis and to seek only comfort care. However, she is bothered by severe SOB with any exertion. Her O2 sats remain above 94% and she does not meet Medicare guidelines for O2 use. I am trying to help her deal with the frustration of taking longer to do simple tasks due to need for energy conservation. As a RN I understand her SOB is related to her chronic anemia and fluid overload. I understand that oxygen may not really help. My question is if she was a hospice patient, could I get her oxygen as a comfort measure as well,, as anxiety and morphine for comfort, as her current MD States she does not meet Medicare guidelines for these now.