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 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

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.

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?

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