The Decision to Stop Eating at the End of Life

Stopping Eating and Drinking to Regain Control at the End of Life

By Angela Morrow, RN

hospital food

The decision to voluntarily stop eating and drinking at the end of life is a choice a patient makes with the intent to hasten the dying process.

Is It Suicide?

No. This is a choice made by patients who are already at the end of their life. A dying person will naturally lose interest in food and fluids and progressively become weaker. When the dying person decides to stop eating and drinking altogether, the process of progressive weakness leading to death occurs days to weeks sooner than would happen if the person were to continue eating and drinking.

To learn more about this expected loss of interest in food and drink, read Where Did Your Appetite Go?

Why Would a Dying Person Choose to Stop Eating?

Most people who choose to voluntarily stop eating and drinking do so to regain or maintain some control over their situation. Reasons people give for making this decision include the desire to avoid suffering, not to prolong the dying process and to take control over the circumstances surrounding their death.

What Kind of Patient Chooses to Stop Eating?

According to a study in the New England Journal of Medicine, which surveyedhospice nurses in Oregon who cared for patients who chose to voluntarily stop eating and drinking, the typical patient is elderly and considers himself to have poor quality of life.

Do Persons Who Choose to Stop Eating Suffer?

Overwhelming evidence says no. The same study in the New England Journal of Medicine found that 94 percent of nurses reported these patients’ deaths as peaceful.

The cessation of eating and drinking is a normal part of the dying process that typically occurs days to weeks before death. Once the body becomes mildly dehydrated, the brain releases endorphins which act as natural opioids, leading to euphoria and often decreased pain and discomfort. When a dying person voluntarily stops eating and drinking, the same process occurs, and they may report feeling better than when taking in nutrition.

Very few patients complain of feeling hungry or thirsty after the first couple of days. Mucous membranes may become dry as dehydration sets in, which is why some patients may want to moisten their mouth with drops of water for comfort.

See: Acts of Love: Caring for a Dying Loved One.

When death by voluntarily stopping of eating and drinking was compared with death resulting from physician-assisted suicide, nurses reported that patients in the former group had less suffering and less pain, and were more at peace than those in the latter group. Nurses reported that both groups had a high quality of death, which sounds strange but means that their deaths proceeded with lower levels of pain and struggle.

How Long after Does Death Occur?

Once a person stops eating and drinking, death usually occurs within two weeks. The person may continue to take small amounts of water to swallow pills or moisten the mouth, and these small sips of fluids may prolong the dying process by a couple of days.

See: The Dying Process: A Journey.

Is Voluntarily Stopping of Eating and Drinking Right for Me?

This is likely a question you never thought you’d ask. But if you are, be sure to discuss this with your physician. She will likely want to make sure that there aren’t treatable conditions, such as depression or untreated pain, that are contributing to your decision. She may also refer you to a social worker or a member of your religious organization (if applicable) to discuss this decision further.

No one can tell you whether you should voluntarily stop eating and drinking. Depending on your quality of life, amount of suffering and personal belief system, you can decide if this choice is right for you.

Complete Article HERE!

Rosemary, That’s For Remembrance

By Sarah Elizabeth Troop

cinderella-at-her-mothers-grave

For many there are no brunches, no flowers, no cakes, no surprise gift planning with other family members in secret on Mother’s Day. Instead, there are those who silently endure the day in pain and mourning for many reasons – the death of a mother, the death of a child, the woman who cannot conceive although she desperately tries and time is not on her side, the mother whose child is missing – all members of a secret club no one wants to join.

You may not be aware of it, but I’m willing to bet someone you know – likely someone you care very deeply for – falls into one of these categories. So, if you are one of the lucky ones – you have a mom you can call to tell her you love her, or a child to hold instead of a grave to visit on Mother’s Day, I’m asking you to please take a moment to reach out to your friends and loved ones this Mother’s Day and help them remember.

rosemary

Rosemary is an herb that has long been associated with remembrance and death. Since ancient Roman times when the herb was used in burial rites for this reason, to several accounts of funerals in England where mourners traditionally tossed bouquets of rosemary on top of coffins. In this respect, rosemary is probably best associated with Shakespeare’s Hamlet, Act 4, Scene 5; “Ophelia in her madness names plants that were known for their capacity to ease pain, particularly inwardly felt pain” [1] – “There’s rosemary, that’s for remembrance; pray, love, remember.” 

rosemary bread

As human beings we have always honored important events and occasions with food and I want to honor your losses, your memories and your feelings of grief on this day, too. Here is a tea bread, you can take to a friend or make for yourself, incorporating rosemary with apples and lemon.

Rosemary, For Remembrance Bread

(Adapted from Nigella Lawson)

Apple mixture:

  •  1 large apple – Pink Lady or Fiji is what I use
  • 1 small sprig plus 1 or 2 long sprigs of rosemary
  • 2 teaspoons granulated or Baker’s sugar
  • juice and zest of 1 lemon
  • 1 tablespoon butter

Cake batter base:

  • 2 sticks of softened butter
  • 3/4 cup granulated sugar plus more for sprinkling over top or casting sugar if you have that
  • 3 eggs
  • 2 cups all-purpose flour
  • 2 teaspoons baking powder

 

Preheat oven to 325˚F. Butter or grease a loaf pan.

Peel, core, and chop the apple and put in a saucepan with the small sprig of rosemary, the 2 teaspoons of sugar, the lemon zest and juice, and 1 tablespoon butter. Cook on low heat for approximately 10 minutes until the apple is soft. Set aside to cool, removing the rosemary sprig once the mixture has cooled.

Put the cooled apple mixture into a food processor and puree. Combine dry ingredients in a bowl. Cream together the butter, sugar and eggs. Combine the butter mixture with the dry ingredients then pour into your prepared pan and smooth the top. Sprinkle the surface with about 1-2 tablespoons of granulated or casting sugar and then lay the rosemary down along the center.

Bake the cake for 45 minutes, checking at the 35-minute mark to see how it’s going. When your cake tester comes out clean, remove from oven and cool. I refrigerated mine once it was cooled, although if you can’t wait, I’m sure it’s good warm as well!

Complete Article HERE!

Cold Food Festival and Qingming Festival (Tomb Sweeping Day)

By Sarah Elizabeth Troop

qingming1

How did an act of cannibalism transform into a national day for honoring  the dead?

As the legend goes, during China’s Spring and Autumn Period following a civil war, Prince Chong Er was forced into exile for 19-years. With him was his loyal minister, Jie. When the pair had run out of food and were starving, Jie cut the flesh from his own leg and made a leg soup from it to feed the Prince, taking loyalty to a whole new level.

When the hard times were over and the Prince became King, he rewarded all those who had remained loyal to him and totally overlooked the guy who CUT THE FLESH OFF HIS OWN LEG TO FEED HIM. Jie packed up his bags and disappeared into the wilderness, taking  his mom with him.

Someone finally confronted the King about his major oversight and feeling ashamed, he went off in search of Jie, but never found him. In result, some idiot suggested setting the entire wilderness on fire to smoke him and his moms out so, that’s just what the king does. Surprise! Still no Jie.

When the fire was extinguished poor, loyal Jie is found dead in the forest , underneath a willow tree, with his mother on his back. Inside the tree is a letter, written in blood from Jie, “Giving meat and heart to my lord, hoping my lord will always be upright. An invisible ghost under a willow tree is better than a loyal minister beside my lord.” Ouch…

In honor of Jie’s death, the King decreed that no fires could be lit on this day and created the Hanshi Festival or “Cold Food Festival,” since food could not be cooked.

Throughout China’s history the Cold Food Festival has been absorbed into the Tomb Sweeping Festival, which occurs on April 4 or 5th each year.

Qingming Festival2

Quingming or Tomb Sweeping Day in China is a day for honoring the dead. The day is reserved for visiting the graves of loved ones. At this time the graves are cleaned and tended to, favorite foods of the deceased are offered and the practice of burning paper goods, “joss paper,” in the form of money and luxury items is practiced. Joss paper has taken many forms in recent years, everything from McDonalds food to IPhones to the more traditional money, ensuring that the deceased is well provided for in the afterlife. It is reassuring to know there is no McDonalds in the afterlife, tho, amirite?

Qingming Festival3

Since the tradition of eating cold food remains a large part of the festival, qing tuan, sweet green rice balls, have been a traditional festival food for some 2,000 years. A  “green rice” dish is also common, containing a mixture of rice powder and green mugworts, stuffed with a sweet bean paste. Both dishes are common offerings to the dead.

Modern elements now include the recent crop of websites where busy families and professionals who cannot travel to the gravesite can choose from different “tomb sweeping packages.”  Professional mourners will go to your loved ones grave, clean and provide traditional offerings. Sobbing or weeping is extra.

Complete Article HERE!