Core Definition & Eligibility

Goal: Comfort, symptom relief, and Quality of Life (QoL); forgoes disease-directed/curative therapy.
Criteria:
- Certified prognosis ≤ 6 months if disease runs natural course (certified by 2 physicians: hospice medical director + attending MD).
- Patient (or designated surrogate) consents to elect hospice benefits and forgoes curative/life-prolonging interventions for the terminal diagnosis.
Flexibility: Pt can revoke at any time to resume curative care; can recertify if decline persists > 6 months.

Hospice vs. Palliative Care

Palliative Care: Any stage of severe illness; provided concurrently with curative care (e.g., chemo, HD).
Hospice Care: Terminal stage (≤ 6 mo); replaces curative intent with pure palliation. c

Pain & Dyspnea: Opioids (Morphine) = 1st-line for both.
- Dyspnea non-pharm: Facial fan, head-of-bed elevation. $O_{2}$ only if hypoxemic.
- Bowel prophylaxis: Mandatory co-prescription of stimulant laxative (Senna/PEG).
Terminal Secretions (“Death Rattle”):
- 1st-line: Reposition pt (lateral decubitus) + reassurance to family.
- Pharm: Anticholinergics (Glycopyrrolate, Scopolamine).
- Avoid: Deep tracheal suctioning (invasive, ineffective, causes trauma).
Terminal Delirium/Agitation: Haloperidol (1st-line). Avoid Benzos (paradoxical agitation/falls).
Anorexia & Dehydration: Do NOT place PEG tubes or start IVF (no survival benefit; ↑ aspiration/edema). Provide mouth swabs and oral comfort feeding as tolerated.

Surrogate Decisions:
- Substituted Judgment (1st-line): Decide what the patient would have chosen.
- Best Interests: Used only if patient’s preferences are completely unknown.
Principle of Double Effect: Giving high-dose opioids to relieve severe pain/air hunger is ethically permissible even if it unintentionally hastens death (intent is palliation, not euthanasia).
Palliative Sedation: Refractory, intractable suffering near EOL $\to$ continuous Midazolam/Propofol infusion.

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