Hospice care is a specialized approach focused on providing comfort and quality of life for individuals with a life-limiting illness. This type of care shifts the focus from curative medical treatments to palliative measures that manage symptoms and support the patient’s physical, emotional, and spiritual well-being. A common question for families concerns the use of intravenous (IV) fluids for hydration, as the decision to withhold or administer them can feel counter-intuitive. Understanding the medical philosophy behind this practice often provides clarity for concerned family members.
The General Approach to IV Fluids in Hospice
Hospice generally limits or avoids the routine administration of artificial hydration, such as IV fluids, because the primary goal has moved away from prolonging life. This approach is rooted in the philosophy that interventions should not add to the patient’s burden or discomfort. Since IV fluids are considered a medical intervention, they must be assessed based on whether they enhance comfort or cause distress.
The body’s physiological needs naturally decrease as the dying process advances, and the desire for fluids often diminishes. Administering fluids to a body that is slowing down can introduce new complications without providing a clear benefit. Therefore, most hospice protocols treat IV hydration as an extraordinary measure rather than a routine part of comfort care.
The standard philosophy emphasizes symptom control over the correction of laboratory values like electrolyte levels. If fluids are deemed necessary for a specific, reversible symptom, they may be used, but not for hydration maintenance. This focus ensures that care aligns with the patient’s overall goal of comfort, avoiding unnecessary medical procedures.
Potential Benefits and Burdens of Artificial Hydration
While families often fear that dehydration causes suffering, artificial hydration can introduce more discomfort near the end of life. The body’s failing organ systems, particularly the kidneys and heart, struggle to process the extra fluid load. This can result in the fluid backing up, leading to fluid overload.
Fluid overload manifests as pulmonary edema, where fluid accumulates in the lungs, causing difficulty breathing, increased congestion, and a distressing cough. It also increases peripheral edema, which is painful swelling in the hands, feet, and face. Furthermore, administering IV fluids may increase the need for catheterization or frequent toileting, which disrupts the patient’s rest and requires additional invasive procedures.
Paradoxically, mild dehydration is a natural and often comfortable aspect of the body slowing down. This state can lead to a slight increase in ketosis, which has a natural analgesic effect. The reduced fluid volume also decreases the production of secretions, which helps prevent the rattling sound of fluid in the throat that can be distressing for families.
In some limited circumstances, a less invasive method called hypodermoclysis, or subcutaneous infusion, may be used for short-term symptom relief. This involves infusing a small volume of fluid, typically less than one liter per day, into the fatty tissue beneath the skin. Hypodermoclysis is not suitable for severe dehydration, but it can be considered for specific, reversible symptoms like delirium caused by fluid imbalance.
Comfort Measures and the Decision Process
When IV hydration is withheld, the focus shifts to meticulous oral care, which is the most effective way to manage the perceived discomfort of thirst and dry mouth. Care teams use soft sponge swabs, often called Toothettes, moistened with water or a specialized oral rinse to clean and moisten the mouth and tongue. Applying moisturizing lip balm or petroleum jelly to the lips prevents cracking and keeps them comfortable.
For patients who are still conscious and able to swallow safely, offering small sips of water, favorite beverages, or ice chips can alleviate thirst. The ice chips melt slowly, moistening the mouth without introducing a large volume of fluid into the body. The goal of these measures is the relief of discomfort, not the correction of fluid deficits.
The decision regarding artificial hydration is a shared process involving the patient, if capable, the family or designated surrogate, and the hospice care team. This conversation requires a careful balancing of the treatment’s potential benefits against its burdens, always prioritizing the patient’s goals for comfort. Open communication ensures that the chosen approach respects the patient’s values and promotes a peaceful experience.