Oxygen Therapy at End of Life

Posted September 1, 2026

Palliative oxygen is routinely prescribed for several reasons including the perception of “doing something”; however, this is not always an appropriate intervention.³

While oxygen therapy is often used at end of life, studies have shown that it provides no significant relief for shortness of breath in people who are not hypoxic. ^1,3,4,5 The routine application of oxygen to people who are near death is not supported.^1,3,4,5 Oxygen should be seen as a pharmacological intervention and not be given based on the assumption of benefit or comfort³

Some literature indicates that opioids often provide better relief of dyspnea than oxygen, even in people who are awake and hypoxic.^1,3,4

Oxygen is often continued into the last hours of life. A person with a decreased level of consciousness will not likely experience air hunger, especially when the person appears calm and comfortable.^3,4 If the patient appears to be experiencing increased work of breathing with tachypnea, use of accessory respiratory muscles, and there is concern about possible distress (as evidenced by facial grimacing or restlessness), consider the use of opioids rather than oxygen.^2,3,4

Opioids are the drug of first choice in the palliation of dyspnea in advanced disease of any cause.²

Note: Oxygen will not correct nor improve end-of-life breathing patterns such as Cheyne Stoke, apnea or agonal breathing.

When Oxygen is Appropriate^1,2,3,4

The patient is awake, hypoxic, and feels breathless. Dyspnea is a subjective symptom, and self report is the gold standard.

The patient prefers oxygen or finds it reassuring.
Whether for medical or psychological reasons, the oxygen clearly reduces distress as seen by slower breathing, less panic, and calmer facial expression. In these cases, you may attempt to educate and pair with opioids, which often provide stronger relief.

When Oxygen is
Not helpful ^1,2,3,4

The patient is unconscious/decreased LOC and appears comfortable.
Oxygen trial does not change breathing comfort or distress.
Oxygen is being used only because numbers (SpO₂) are low —at end of life, we expect these numbers to decrease. Treat the person, not the numbers.
The family’s goal is comfort, not prolonging life. In these situations, oxygen may prolong dying without improving comfort.
Avoid initiating oxygen during the active dying phase when the person is already experiencing decreased consciousness, as family may have increased association of the withdrawal of oxygen with the withdrawal of life-sustaining measures.
Oxygen can cause discomfort, dryness, irritation, or claustrophobia, and tubing can cause skin irritation/breakdown behind the ears.

What you might
do instead²

Model a calm approach and breathing pattern.
Assist the person to a comfortable position.
Consider increasing air flow with open window, door, room fan or handheld fan.
Apply a cool cloth to side of face (trigeminal nerve) to help reduce sensation of breathlessness.
Consider the environment: lighting, noise, crowding.
Identify/address possible underlying causes.
Medicate with opioids (opioids may be more effective than anxiolytics when anxiety is due to dyspnea).

Resources

Does oxygen usage prolong life or is it for comfort care? Canadian Virtual Hospice
Hospice Palliative Care Program (July 17, 2006). Symptom Management Guidelines – Dyspnea. Fraser Health.
Clemens KE, Quednau I, Klaschik E. Use of oxygen and opioids in the palliation of dyspnoea in hypoxic and non-hypoxic palliative care patients: a prospective study. Support Care Cancer. 2009;17:367-377.
Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010;376:784-793.
Campbell M, Yarandi H, Dove-Medows E. Oxygen Is Nonbeneficial for Most Patients Who Are Near Death. Journal of Pain and Symptom Management, 2012; 45, 517-523

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