The dying process is still a mystery to most of the living, including the Florida Legislature, says Hank Dunn.

In October, Florida lawmakers passed "Terri's Law," permitting Gov. Jeb Bush to order a feeding tube reinserted in Terri Schiavo, brain damaged and on a feeding tube since 1990. Earlier, her husband had successfully petitioned a Florida court to allow the tube removed.

"They're starving that woman to death. What a horrible way to die," one of the lawmakers said before Bush intervened. To which Dunn replies: not true.

Dunn, a chaplain who has worked in nursing homes and hospice organizations, is author of "Hard Choices for Loving People." He spoke Thursday at a statewide meeting sponsored by the Utah Partnership to Improve End-of-Life Care.

Withdrawal from food and water is in fact a peaceful way to die, Dunn says. "It's the way we've done it since the beginning of time." Sometimes, says Dunn, feeding a patient artificially actually prevents a peaceful death.

The Schiavo case is more complicated than most, not only pitting family members against each other in a legal battle, but highlighting medicine's inability to accurately understand the brain activity of "vegetative" patients. Most feeding-tube cases, on the other hand, involve patients who are already clearly in the process of dying.

For these patients, Dunn says, artificial hydrating and feeding can create a more painful death. A study comparing dying patients with and without feeding tubes found more pain-reducing, naturally occurring endorphins in the patients without tubes.

Withholding artificial hydration in dying patients, Dunn reports, causes less fluid in the lungs and throat, less pressure around tumors (and therefore less pain) and less fluid retention in general. In addition, contrary to popular opinion, intravenous fluids do not quench a patient's thirst, he says.

Sometimes, artificial nutrition and hydration is necessary — in patients recovering from throat cancer, for example, who are well but cannot swallow; or patients who may have stopped eating because of depression. But patients with advanced dementia should not be on feeding tubes, he argues.

Seventy-two studies over 33 years have shown, he says, that advanced dementia patients are actually more likely to develop aspiration pneumonia and serious infections from the tube, and are no more likely to live longer. A better, although more time-consuming, method is "careful hand feeding" of these patients.

Families often request tube feeding for their patient for "emotional and spiritual" reasons, Dunn says. "From the very beginning of life, when we care about someone we feed them." But sometimes families don't realize they can refuse a feeding tube, or can withdraw a feeding tube later on, he says.

Patients and families also sometimes request CPR in patients who are clearly dying of terminal diseases. Hospice workers and others who work with the dying would do well, Dunn says, to try to get to the bottom of the patient's and family member's underlying fears.

"They might have a right to be a 'full code,' but we're not doing them any favors," he says about CPR. Deciding whether or not to request CPR "is not a life-and-death decision, it's a death-and-death decision" in these cases, he says. A study of 26,000 hospitalized patients who received CPR revealed that only 15 percent survived long enough to be discharged.

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E-mail: jarvik@desnews.com