Hospice care is specialized medical support provided to individuals with a limited life expectancy, focusing on comfort and quality of life rather than cure. Hospice unequivocally treats infections, though the goal of that treatment is distinctly different from acute medical care. Hospice addresses infections not to prolong life indefinitely, but to relieve discomfort and maximize the patient’s well-being. This approach ensures a patient’s final months are spent with the highest possible level of peace and physical ease.
Palliative Focus Versus Curative Intent
The foundational difference between acute care and hospice is the goal of treatment, which shifts from a curative to a palliative focus. Curative care involves aggressive interventions aimed at eliminating disease or extending life. When a person enters hospice, the primary goal transitions to managing symptoms and maximizing comfort, accepting that the underlying terminal illness will progress.
In this setting, treating an infection is a means to achieve comfort, not to reverse the dying process. An infection, such as a urinary tract infection, can cause significant distress through fever, pain, and confusion. Treating the infection with antibiotics works to remove the source of suffering, which is the core mission of palliative care.
The focus is on managing acute symptoms rather than pursuing an aggressive course to extend life. This philosophical shift distinguishes hospice care from other medical settings where all possible measures are taken to combat the disease. Therefore, an infection is treated because it is causing suffering, not merely because it is a treatable condition.
Infection Management for Comfort
The practical application of infection management in hospice is tailored to minimize invasiveness while effectively controlling symptoms. Common infections include urinary tract infections (UTIs), skin infections, and aspiration pneumonia, all of which severely impact comfort. When an infection is highly symptomatic, antibiotics are frequently prescribed to provide rapid relief.
The selection and route of administration for antibiotics prioritize patient comfort and ease of use over the aggressive, high-dose regimens typical in a hospital setting. Oral antibiotics are the first choice when a patient can swallow and tolerate medications, as they are the least invasive. If the patient is unable to take oral medication due to swallowing difficulties or weakness, the subcutaneous route is often utilized.
Subcutaneous administration involves injecting medication into the fatty tissue beneath the skin, a method that is less painful and more easily managed at home than an intravenous (IV) line. This route allows for the delivery of certain antibiotics without the need for hospitalization. Non-drug measures also play a significant role, including proper positioning, hydration, and fever-reducing medication like acetaminophen to manage the patient’s response to the infection.
Patient and Family Decision-Making
All decisions regarding infection treatment in hospice are guided by the patient’s established goals of care and personal wishes. The hospice team facilitates a frank discussion with the patient and family about the potential benefits of treatment, such as symptom relief, weighed against the possible burdens. Aggressive treatment, such as hospitalization and IV antibiotics, can introduce distress, side effects, and a loss of autonomy, which may compromise the patient’s quality of life.
Patients and their families have the right to elect to forgo any treatment for an infection, a decision often referred to as allowing a “natural death.” This choice reflects a belief that the infection is a natural progression of the terminal illness and that intervention would only prolong the dying process or cause unnecessary suffering. Discussions around antibiotic use are considered as important as those concerning advance directives, such as Do Not Resuscitate (DNR) orders.
The initial care plan and ongoing conversations ensure that the medical response to an infection aligns with the patient’s ultimate priority. The hospice team provides guidance, but the patient’s autonomy and their definition of a good quality of life remain the final determinant for all medical interventions. This shared decision-making model ensures that treatment remains focused on the patient’s personal wishes for their end-of-life experience.