The patient s ability to communicate is taken into account, and caregivers try to avoid inflicting pain. Throughout the process of withdrawing support, Dr. Faber-Langendoen said that physicians and caregivers should remember that most dying patients want to see explicit concern about their comfort, and they want to end interventions that don t directly contribute to that comfort. Patients families and physicians agonize over discontinuing food and water in part because they may fear it brings suffering and death. Panelist Steven Pantilat, ACP-ASIM Member, director of inpatient palliative care services at the University of California, San Francisco, pointed to evidence that discontinuation of food and fluids produces a euphoric ketosis that prevents suffering. Dr. Faber-Langendoen, however, cited conflicting evidence from a study she published that concluded, patients able to swallow without aspirating should be offered fluids and food as part of comfort care.
Discontinuing ventilation Discontinuing ventilation poses some of the most difficult problems.
Prolonged terminal-weaning allows titration of drugs to control dyspnea, maintains an airway for suctioning and permits a greater emotional distance between the act of withdrawal and the patient s death. It may prolong the dying process, however, leading family members to believe survival is still possible, and it precludes any chance of verbal communication. Rapid terminal-weaning, on the other hand, is less likely to prolong the dying process. However, verbal communication remains impossible because the patient usually dies quickly. Extubation frees the patient from unwanted technology, but if anticipatory sedation is not administered, the patient may suffer dyspnea.