What do you think of when you hear comfort care? Do you think of pulling the plug, doing nothing, or just laying there dying? I suppose one’s definition of comfort care depends on what one thinks dying is. If you think of dying incorrectly like the majority of the world, like a thing which just happens when it happens, that warns you right before that it'll happen, and that happens in a way where you can continue to interact, like a deathbed scene in the movies, then of course comfort care is nothing done, the absence of care at the end.
But if, like I do, you understand that dying begins much, much earlier than active transitioning - as early as right after being born - and that managing dying means being realistic about managing what can be managed to provide comfort but not irrationally seeking cure of the incurable at all cost, then comfort care takes on a new and fleshed-out meaning.
My comfort care in hospice includes virtually everything, and I am not embarrassed to admit it. Even among hospice providers there's still a myth that dying takes minimalistic management. But I know that the process of decline and keeping someone comfortable, as symptom-free and as interactive and experiencing life as they can, takes all modalities, all measures. I have used antibiotics, fluids, procedures, wound care, ventilation, infusions, and every form of medication - transdermal, oral, sublingual, topical, rectal, nebulized, subcutaneous, intravenously - to palliate a multitude of symptoms.
I believe that quality care is based on knowing decline and death intimately well in order to instinctively recognize what is futile and what is necessary for care. For me, nothing which palliates the patient is off the table. I'm willing to consider it all as long as it is genuinely, globally feasible and makes sense. If it is trying to prolong life at all cost, like fluids when transitioning or antibiotics for that final aspiration event, or another round of chemotherapy when the patient can barely function anymore, it's not comfort. But comfort care is not nothing either. It's everything - yes, everything - in between.