"You go into a uremic coma. You go into a stuporous state, and you stay that way until you die," said William A. Knaus, who co-directed the intensive care unit at George Washington University Medical Center for 20 years and is now at the University of Virginia. "There is absolutely no indication that the body reacts to this with stress."
Storey said that in his hospice practice he has "sat at the bedside of thousands of patients as they died, and many of them could tell me how they were feeling when they had gone weeks without eating and drinking." What they told him, he said, was that they did not feel bad at all. Their chief discomfort was a dry mouth. That could be relieved by sips of water or by swabbing the mouth with a water-soaked sponge.
Exactly what hastens death and what makes it more or less tolerable is largely unknown.
Lynn, a geriatrics specialist in suburban Maryland who also serves in the organization Americans for Better Care of the Dying, said end-of-life care is full of beliefs and practices untested by research.
For example, doctors do not know what the best form of sedation is for people suffocating from respiratory failure. Most physicians believe that liberal use of morphine hastens death. But it may not. People who receive it may actually survive longer.
"Nobody has studied it because nobody cares. There is not a National Institute of Advanced Illness," she said.
Part of the resistance comes from a belief that the dying should be beyond the reach of medical experimentation.
Storey said he once proposed a clinical trial to determine whether giving hospice patients intravenous fluids made them more comfortable. One group would be assigned to get the fluids while another would take only the fluids they wanted by mouth. Storey was then going to survey them about how they felt.
Hospices, however, generally frown on IV lines as invasive devices best left behind when a cure is no longer possible. Storey said the review committee at his institution rejected his protocol, saying it was unethical.
