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Terminal dehydration is
dehydration In physiology, dehydration is a lack of total body water that disrupts metabolic processes. It occurs when free water loss exceeds intake, often resulting from excessive sweating, health conditions, or inadequate consumption of water. Mild deh ...
to the point of death. Some scholars make a distinction between "terminal dehydration" and "termination by dehydration". Courts in the United StatesNL Cantor (1987). Legal frontiers of death and dying. Indiana University Press. , pp. 28-29. generally do not recognize prisoners as having a right to die by voluntary dehydration, since they view it as
suicide Suicide is the act of intentionally causing one's own death. Risk factors for suicide include mental disorders, physical disorders, and substance abuse. Some suicides are impulsive acts driven by stress (such as from financial or ac ...
.


Progression

During terminal dehydration, the usual symptoms of dehydration, such as
headache A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of Depression (mood), depression in those with severe ...
and leg cramps, can occur. Unlike many other suicide methods, it cannot be accomplished impulsively. However, a "point of no return" can eventually be reached at which, should it be desired to abort the terminal dehydration, rehydration cannot be accomplished through simple
oral rehydration therapy Oral rehydration therapy (ORT) also officially known as Oral Rehydration Solution is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. It involves drinking water with modest amounts of sugar and salt ...
; rather, it will require medical assistance such as
intravenous therapy Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...
. Those who die by terminal dehydration typically lapse into unconsciousness before death, and may also experience
delirium Delirium (formerly acute confusional state, an ambiguous term that is now discouraged) is a specific state of acute confusion attributable to the direct physiological consequence of a medical condition, effects of a psychoactive substance, or ...
and altered serum sodium. Patients with
edema Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...
tend to take longer to die of dehydration because of the excess fluid in their bodies. Dehydration has been known to cause a sense of "mild euphoria", provided no intravenous is used.


Voluntary

Terminal dehydration (also known as voluntary death by dehydration or VDD) has been described as having substantial advantages over physician-assisted suicide with respect to
self-determination Self-determination refers to a people's right to form its own political entity, and internal self-determination is the right to representative government with full suffrage. Self-determination is a cardinal principle in modern international la ...
, access, professional integrity, and social implications. Specifically, a patient has a right to refuse treatment and it would be a personal assault for someone to force water on a patient, but such is not the case if a doctor merely refuses to provide lethal medication. Some physicians believe it might have distinctive drawbacks as a humane means of voluntary death. One survey of hospice nurses in Oregon (where physician-assisted suicide is legal) found that nearly twice as many had cared for patients who chose voluntary refusal of food and fluids to hasten death as had cared for patients who chose physician-assisted suicide. They also rated fasting and dehydration as causing less suffering and pain and being more peaceful than physician-assisted suicide. Patients undergoing terminal dehydration can often feel no pain, as they are often given sedatives and care such as mouth rinses or sprays There can be a fine line between terminal sedation that results in death by dehydration and
euthanasia Euthanasia (from : + ) is the practice of intentionally ending life to eliminate pain and suffering. Different countries have different Legality of euthanasia, euthanasia laws. The British House of Lords Select committee (United Kingdom), se ...
. Studies have shown that for terminally ill patients who choose to die, deaths by terminal dehydration are generally peaceful, and not associated with suffering, when supplemented with adequate pain medication. All ages may feel sudden head rushes, dizziness, and loss of appetite, as well. Members of the Buddhist
Sokushinbutsu is a type of Buddhist mummy. In Japan the term refers to the practice of Buddhist monks observing asceticism to the point of death and entering mummification while alive. Although mummified monks are seen in a number of Buddhist countries, espe ...
sect of Japan historically practiced a form of self-mummification which in part was achieved by the forgoing of all food and liquid until death.


Involuntary

In the
Netherlands , Terminology of the Low Countries, informally Holland, is a country in Northwestern Europe, with Caribbean Netherlands, overseas territories in the Caribbean. It is the largest of the four constituent countries of the Kingdom of the Nether ...
debate has broken out about terminal dehydration, which is referred to as '. There have been accusations that involuntary dehydration takes place in
nursing home A nursing home is a facility for the residential care of older people, senior citizens, or disabled people. Nursing homes may also be referred to as care homes, skilled nursing facilities (SNF), or long-term care facilities. Often, these terms ...
s. Another doctoral thesis found no evidence of forced-upon "versterving" in nursing homes. There was, however, voiced vehement opposition considering assistance for those who voluntarily abstained from food and drink.


See also

* Heat illness *
Hypovolemia Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the loss ...
*
Hypovolemic shock Hypovolemic shock is a form of Shock (circulatory), shock caused by severe hypovolemia (insufficient blood volume or extracellular fluid in the body). It can be caused by severe dehydration or blood loss. Hypovolemic shock is a medical emergency ...
*
Fasting Fasting is the act of refraining from eating, and sometimes drinking. However, from a purely physiological context, "fasting" may refer to the metabolic status of a person who has not eaten overnight (before "breakfast"), or to the metabolic sta ...
*
Medical food Medical food is food that is specially formulated and intended for the dietary management of a disease that has distinctive nutritional needs that cannot be met by normal diet alone. In the United States, it was defined in the Food and Drug Admin ...
* Terri Schiavo case


References

{{Nutritional pathology Euthanasia Suicide by starvation and dehydration