WooHoo, what a touchy topic. Responses are interesting here, even in this column. Interesting response by leslie "infections hurt and need to be treated(as long as it's not related to the adm. diagnosis)". Hmmm, I have seen too many of Leslie's responses to believe that she means "we can treat them if they hurt for something that's not related to the terminal diagnosis, but not if it is related to the terminal diagnosis". Leslie's responses are too humane for that type of intended response. We all have personal opinions here, so here goes mine:
We treat symptoms and promote comfort. Hospice is a philosophy of care, and that philosophy is different to different cultures, families and individuals. We really do "have to listen and know our patients", asShariWN admirably states. This is not about our opinions, but rather, about the patient and the family unit. How often does an AIDS patient actually die from the disease itself????(very rarely--death is usually from an opportunistic infection) If we treat every single opportunistic infection that pops up during the course of the hospice AIDS patient, we are, in all likelihood, going to cause suffering to that patient, and to that family unit. Our jobs as hospice professionals is to listen, to guide (when asked)and to promote comfort always. Many disease courses, Alzheimer's, Failure to Thrive, have a very, very low mortality rate of themselves. The "killers" in FTT or Alzheimer's patients are the pneumonias, UTI's and aspiration events. How long do we continue to treat these? Always, per request, sometimes per guidance, and rarely if we are at a point where the family is on board, the patient is ready and if the infection is causing no discomfort.
If the patient and family have accepted the philosophy of care----we treat the symptoms and provide the comfort and the tools to say goodbye. Recently read a large study with geriatric population and mis-use, abuse of antibiotics for common infections URI's,UTI's----arrrrgggghhhhh, can't find the reference for this column, but the results were favorable towards not treating every infection in the elderly. Along with treating infections comes the risk of C-Dif, fungal and yeast infections and thrush (all of which can be more uncomfortable than the original infection) along with unintended potential side effects, diarrhea, decreased appetite, confusion, psychosis and the set-up for super-infections if we are not able to get every single dose down the patient .Several studies show "less is best" when it comes to adding medications to the elderly patient's regime. Absolutely, DNR does not mean Do Not Treat--- but personal preference is treating the symptoms and allowing nature to take it's course if the patient and family have accepted the philosophy. Very, very frequently, the current pneumonia or UTI (that could lead to sepsis and death) is a much, much more humane death than what is around the corner for patients of certain diseases (metastatic bone cancer, COPD, SC lung, ALS, etc).
Okay, that's my personal opinion, now, have at it.....