Just like hospice regulations were created decades ago, end of life doulas functions are now being formalized. Hospice performs the medical, doulas do not. During a Question and Answer session with a group of end of life doulas I was presented with the question, “Is mouth care at end of life considered medical or comfort care?"
It had never occurred to me that someone would think taking care of someone's dry mouth would be considered medical. I was startled by the question. Upon further thinking I realized in today’s litigious, medicalized, bureaucratic society we can take actions to extremes and that something as simple as mouth care can be questioned. SO —— here are my thoughts on comfort care vs. medical mouth care.
There is nothing medical about brushing your teeth, rinsing your mouth or moistening the inside of your mouth. We do it all the time. Why would it be suddenly considered a medical procedure just because the body is dying?
The answer --- it wouldn’t, at least it shouldn’t. Providing mouth care as end of life approaches is keeping a person comfortable, is comfort care, and anyone, no matter if there are letters after their name or not, whether they are paid or not, should be able to provide it.
Is there a right or wrong way to provide mouth care at end of life? Maybe. The biggest “danger” would be choking on the water put in the mouth. If the person is responsive, help and support them in brushing their teeth and rinsing their mouth. There should be no problem here although it may be a bit messy.
If the person is confused or non responsive, they are probably breathing with their mouth open so the tongue and inside of their mouth will become dry. Also, anyone getting oxygen will have dry mouth from the additional air flow into the mouth and throat area.
Use moist or glycerin swabs from the drug store (if swabs have mouthwash in them you may want to dilute with a bit of water as the mouthwash can be too strong) or even a wet toothbrush to gently wipe the inside of the mouth and tongue. You don’t want any real quantity of fluid in the mouth because if they aren’t aware to swallow there can be a situation for choking.
Other comfort things to think about: A bit of vaseline spread on the lips can ease dry lips. If the person is alert, popsicles made from fruit juice can help.
Dying is not a medical event. It is a social, communal event AND, most importantly, it is a natural event. It is the body doing what it is naturally programmed to do. We can ease its transition by keeping it as comfortable as we can. Sometimes our natural body functions need a bit of an assist. Mouth care is one of those things.
Something More... about Is Mouth Care Considered Medical or Comfort Care at End of Life?
My booklet, The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death, offers information, ideas and support for caregivers in the weeks, days, and hours before death and just after. Having this information inspires and empowers the caregiver while reducing fear. Mouth care is part of this booklet. It is also part of the dvd kit for NEW RULES for End of Life Care and is one of the booklets in the End of Life Guideline Series.