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

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

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.

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