When a person is approaching the end of life, supplemental oxygen is a common intervention used to manage symptoms within hospice or palliative care. End-of-life care focuses on comfort and quality of life rather than cure, addressing the physical, emotional, and spiritual needs of the patient and their family. The decision to continue or discontinue oxygen therapy requires careful evaluation of whether the intervention still serves the goal of patient comfort. This evaluation shifts the focus from prolonging life to ensuring dignity and peace during the final stages of a terminal illness.
The Palliative Goal of Oxygen Therapy
In the end-of-life setting, oxygen is administered with a different intention than in acute medical care. Unlike its use to correct dangerously low oxygen saturation (hypoxemia), the primary goal in palliative care is to treat dyspnea, the subjective feeling of shortness of breath or “air hunger.” Dyspnea is a distressing symptom affecting many patients with advanced illnesses like Chronic Obstructive Pulmonary Disease (COPD) or heart failure.
Oxygen therapy functions as a comfort measure, aiming to reduce the patient’s perception of breathlessness and associated anxiety. This approach recognizes that breathlessness does not always correlate directly with measured oxygen saturation. Studies show that for patients who are not hypoxemic, supplemental oxygen may be no more effective than compressed room air for relieving dyspnea.
The therapy is viewed as a treatment for a symptom rather than a life-sustaining measure intended to alter the disease’s trajectory. Administering oxygen in this context will not prolong life significantly, nor does stopping it hasten death. When oxygen no longer provides subjective relief or the illness progresses to its final stage, its therapeutic role is complete.
Clinical Indicators for Discontinuation
The decision to discontinue oxygen is based on a clinical assessment focused entirely on the patient’s comfort and response to the therapy. The primary indicator is the lack of subjective benefit, meaning the patient reports or shows no relief from breathlessness despite its use. In these cases, the oxygen has ceased to function as a comfort measure.
Another factor is increasing patient discomfort caused by the delivery device itself. The nasal cannula or mask can cause skin irritation, nasal dryness, or a feeling of claustrophobia that outweighs any potential breathing benefit. If the equipment becomes a source of distress, its continued use violates the goal of comfort-focused care.
As the body begins to shut down, patients often become unconscious or significantly more drowsy. In this deeply unconscious state, the patient can no longer experience the subjective feeling of air hunger, and oxygen provides no measurable comfort. Continuing oxygen in an unconscious patient who derives no benefit adds burden and complexity to care.
The overall decline in the patient’s condition, where even high flow rates fail to improve saturation levels, signals that the body can no longer utilize the oxygen effectively. The rationale for discontinuation rests on the principle that the burden of the treatment, including noise and irritation, outweighs the perceived benefit. The focus shifts away from numerical oxygen saturation targets and entirely toward observable signs of comfort.
Navigating Emotional and Ethical Concerns
The suggestion to stop oxygen often presents a significant emotional hurdle for family members and caregivers. They may fear that removing the therapy is equivalent to “giving up” or actively hastening death, a concern stemming from the cultural perception of oxygen as life support. The palliative care team must engage in open, compassionate communication to address this fear directly.
The concept of “allowing a natural progression” must be clearly explained. Oxygen discontinuation in a terminally ill patient is not an act of hastening death; rather, it removes a medical intervention that is no longer serving a therapeutic purpose and may be causing unnecessary discomfort. This aligns with the ethical principle of nonmaleficence, the duty to do no harm.
Care teams often frame the decision as a transition to a different, more effective set of comfort measures rather than a withdrawal of care. Discussions should focus on the patient’s wishes and goals, ensuring that dignity and peace remain the paramount objectives. Reassurance that the patient will not suffer or struggle for air is fundamental to supporting the family through this transition.
Alternative Strategies for Respiratory Comfort
Once oxygen is discontinued, pharmacological and environmental strategies are implemented to ensure the patient’s respiratory comfort is maintained. Pharmacological management is the most effective approach for treating air hunger in the end-of-life phase. Low-dose opioids, such as morphine, are considered a primary treatment for dyspnea, as they work by altering the brain’s perception of breathlessness.
Benzodiazepines, such as lorazepam, are often used as an adjunct to manage the anxiety and distress that frequently accompany air hunger. These medications help to calm the patient, reducing the panic that can exacerbate the feeling of shortness of breath. The goal is to provide relief without causing undue sedation.
Non-pharmacological and environmental adjustments also play a significant role in maintaining comfort. Using a small fan to blow a gentle stream of cool air across the patient’s face is an effective technique that stimulates nerves, reducing the sensation of breathlessness. Simple positioning changes, such as sitting the patient upright or leaning them forward slightly, can also ease the work of breathing. Frequent mouth care helps manage oral dryness, which is often a source of irritation.