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Ethical and Clinical Considerations in Treating Infections at the End of Life

Vaughan, Leigh, MD, FHM, FAAHPM; Duckett, Ashley A., MD, FHM; Adler, Mary, ANP-C, ACHPN; Cain, Joan, FNP-BC, ACHPN

Journal of Hospice & Palliative Nursing: April 2019 - Volume 21 - Issue 2 - p 110–115
doi: 10.1097/NJH.0000000000000541
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Patients often affirm the goal to pursue comfort at the end of life, although clinicians may struggle with how best to provide comfort and face the ethical dilemma of treating or allowing a suspected infection to unfold. Treating an infection at the end of life does not allow for uniform improvement in symptoms and more time with family and friends. Additionally, there is potential for burden to the patient or health care system and treatment may occur to the exclusion of other comfort measures. Currently, the practice of providing or forgoing antibiotics at the end of life is variable, and literature supporting best practices can be contradictory. Data to support the use or withholding of treatment have been scant and vary across settings and patient populations. We review common obstacles providers face, prognostication tools that may assist in clinical decision making, the ethical support for withholding therapy, and how to factor in potential burdens of treatment. We propose that nurses, whether at the bedside in an acute care or nursing facility or in the home setting as a member of the interdisciplinary home hospice team, are uniquely qualified to help patients and families navigate this challenging clinical decision.

Leigh Vaughan, MD, FHM, FAAHPM, is assistant professor and fellowship director, Hospice and Palliative Medicine, Department on General Internal Medicine, Medical University of South Carolina, Charleston.

Ashley A. Duckett, MD, FHM, is assistant professor and associate program director, Department of Internal Medicine, Medical University of South Carolina, Charleston.

Mary Adler, ANP-C, ACHPN, is nurse practitioner, palliative care team, Medical University of South Carolina, Charleston.

Joan Cain, FNP-BC, ACHPN, is nurse practitioner, palliative care team, Medical University of South Carolina, Charleston.

Address correspondence to Leigh Vaughan, MD, FHM, FAAHPM, Department on General Internal Medicine, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC 29425 (vaughanl@musc.edu).

© 2019 by The Hospice and Palliative Nurses Association.