The use of oxygen therapy for a person nearing the end of life often raises questions, as the body’s natural processes are slowing down. This intervention is not intended to reverse the disease trajectory or restore full health. Instead, the administration of oxygen in end-of-life care is fundamentally a comfort measure. The focus shifts from attempting to cure the underlying illness to managing distressing symptoms and supporting the patient’s quality of remaining life. At this stage, the goals of treatment are centered entirely on promoting peace and dignity.
The Primary Role of Oxygen in Comfort Care
The central medical reason for providing supplemental oxygen to a dying person is to alleviate dyspnea, which is the subjective feeling of breathlessness or air hunger. This sensation is profoundly distressing and can lead to anxiety, fear, and panic. Oxygen is administered to reduce the intensity of this discomfort, even if it does not significantly change the overall medical outcome.
The feeling of shortness of breath does not always correlate directly with low oxygen levels in the blood. A person may have adequate oxygen saturation but still feel like they are suffocating due to complex physiological signals. In these cases, the psychological and physical comfort derived from the administration of oxygen is the primary therapeutic goal.
Supplemental oxygen is typically delivered using a low-flow device like a nasal cannula, which consists of small prongs placed just inside the nostrils. This method is preferred because it is non-invasive and allows the patient to speak and eat more comfortably than a face mask. The choice of delivery method and flow rate is determined by the patient’s comfort and tolerance, prioritizing ease over aggressive intervention.
In some situations, a low flow of compressed air, rather than pure oxygen, delivered via the nasal cannula has been shown to be equally effective in relieving breathlessness in patients who are not significantly hypoxic. This suggests that the sensation of cool air movement across the face and nasal passages contributes to the relief experienced. However, oxygen is often used because it is readily available and psychologically reassuring to both the patient and their family.
Palliative Versus Curative Intent
The decision to use oxygen near the end of life marks a definitive shift from curative to palliative intent. Curative care focuses on treating the underlying disease for recovery or long-term survival, often using oxygen aggressively to maintain vital organ function. In the palliative setting, the disease is recognized as being in its final, irreversible stage, and the goal is no longer to prolong life.
When a person is dying, the administration of oxygen is not expected to halt the natural progression of the disease or significantly extend the person’s lifespan. The body’s systems are shutting down, and oxygen saturation may drop regardless of the supplemental oxygen provided. The intent is purely humanitarian, aiming to reduce suffering during the natural dying process rather than medically intervening to sustain life.
This distinction is crucial for family members and caregivers to understand, as oxygen equipment can create the misconception that a life-saving measure is still being employed. The medical team focuses on ensuring the patient remains peaceful and free from the frightening sensation of air hunger. Therefore, oxygen is seen as a comfort medication, similar to how pain relievers manage physical pain.
In critical care settings, oxygen is used aggressively to maintain systemic function. However, in hospice or palliative care, the philosophy changes entirely. The goal is to maximize the quality of the time remaining by focusing on symptom control and emotional support. Oxygen, in this context, is one tool in a comprehensive comfort-focused plan.
Assessing Effectiveness and Burdens
The effectiveness of oxygen therapy in end-of-life care is primarily assessed by monitoring the patient’s subjective comfort level, rather than relying on technical measurements. The care team observes the patient for signs of reduced distress, such as less restlessness, a calmer breathing pattern, or a verbal report of feeling less breathless. If the patient appears more relaxed after the oxygen is started, the therapy is considered beneficial.
Monitoring oxygen saturation levels (SpO2) with a pulse oximeter becomes less important than monitoring the patient’s appearance and self-reported comfort. The focus shifts away from numerical targets, as maintaining a specific saturation percentage is not the goal in palliative care. If the patient is comfortable, a low saturation reading is accepted as part of the natural dying process.
Supplemental oxygen can become a source of discomfort, especially at higher flow rates, which can be drying to the nasal and throat passages. The tubing itself can be irritating, or a mask may feel restrictive and claustrophobic, potentially increasing the patient’s anxiety and sense of breathlessness. If the oxygen causes more distress than relief, it is appropriate to reduce the flow or discontinue the therapy entirely.
The decision to withdraw oxygen is made if the therapy is no longer providing symptomatic relief or if it is actively creating a burden for the patient. Other treatments, such as low-dose opioid medications, are often more effective at managing the sensation of breathlessness than oxygen, especially when the patient is not hypoxic. The goal remains consistent: to ensure the patient’s final days are as comfortable and peaceful as possible.