outline

1. Comfort Care
Care given to improve the quality of life of patients who have a serious or life-threatening
disease. The goal of comfort care is to treat the symptoms of a disease, and psychological,
social, and spiritual problems related to a disease or its treatment. Also called palliative care,
supportive care, and symptom management. This involves the withholding of life sustaining
treatment and the hastening of death.
Comfort Care - This kind of order is generally appropriate only for a patient with a terminal
illness and/or short life expectancy. This can include end stage dementia.
End stage dementia eligibility criteria for comfort care:
• Unable to ambulate without assistance
• Unable to dress without assistance
• Unable to bathe without assistance
• Urinary or fecal incontinence, intermittent or constant
• No meaningful verbal communication, stereotypical phrases only, or ability to speak
limited to six or fewer intelligible words
(Appropriateness for Comfort Care can be debated and should be case by case but)
APA guidelines for Comfort Care:
1)the patient should not have a temporary but treatable psychiatric disorder that is
influencing the decision; 2) the decision should be carefully considered and should not be
impulsive-a reasonable amount of time for consideration should be insisted on before a
decision; 3) there should be no undue influence by faculty or heirs, particularly those who
would financially benefit from the patient's death;4) the patient must understand the risks
and benefits that relate to withholding continuing care and treatment; 5) in certain
unusual situations, a patient should be kept alive to allow for a full assessment and a
resolution of certain problems, especially legal ones.
If the patient does not have decision-making capacity, the decision cannot be made if he is
expected to regain decision-making capacity. In all cases, if the patient’s wishes and/or decision-
making capacity are unclear treatment should be provided not withheld.