My mother's lung cancer has returned and is now incurable. As hospital discharge approaches, my father, siblings and I had a conversation with a Hospice representative (nurse) in the hospital.

Everything she said sounded wonderful, until I asked her their policy on IV fluids and tube feeding. She flat out said it is against their policy, that these are "extraordinary measures" (it is my understanding the Church says they are not). She went on to explain that tube feedings and IV fluids often cannot be processed by the dying person's body and do more harm than good. I understand this, but the question remains in my mind, shouldn't this be evaluated on a case-by-case basis rather than having a blanket policy against assisted nutrition and hydration? Might there be cases where the patient experiences hunger and thirst but has difficulty swallowing?

None of my siblings nor my father seemed concerned about the policy. If I challenge it, I will probably be the lone voice in our family (I am one of eight children, my parents are practicing Catholics, some of my siblings have abandoned their Catholic faith to varying degrees). We are a close family (although scattered geographically) and all want what is best form Mom.

Mom and Dad have DNR orders, living wills which I think preclude extraordinary measures (I have not seen the exact wording, but my sister indicates that tube feedings would be ruled out).

Do different local Hospice organizations have different policies? The hospital where we met with the Hospice nurse is in a different county from where my mother lives, so I am thinking the Hospice where Mom lives could have different policies.

How do I proceed? I want to be able to ask the right questions of the right people without creating a huge battle.

Dear NWZ

Indeed each case is different and a blanket policy denying the provision of nutrtion and/or hydration by tube is not only inhumane but irrational. We all know of cases where a patient who entered hospice has recovered and gone on to live a good life.

So, my advice is to either sit down with hospice and explain to them why the policy is a violation of your parents' patient rights, and further explain the fundamental reasons why the provision of nutrition and hydration is not extraordinary means of "treatment" but rather comfort care for the dying. If the body rejects the provision of nutrition and hydration, then of course it cannot be administed, but this does not occur one hundred percent of the time.

Discussing these matters with hospice administrators will give you the answers you need about their respect for your mother's dignity and at that point, the family may have to make alternative arrangements for her care.

Judie Brown

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