hospice

As established by the great medical humanitarian, the late Dame Cecily Saunders, hospice was designed to treat “total pain” of patients — whether physical, emotional, or spiritual — to the end of ensuring that the care offered is about living, not just death. When it works as intended, as it did for both my parents, the beneficence offered to patients and their families cannot be quantified.

Alas, the hospice movement is in serious trouble. I can’t tell you how often now people approach me after a speech or call in on talk radio to tell me that they do not trust hospice to properly care for their loved ones.

Why has this happened? My friend Ira Byock, the great palliative doctor and author of Dying Well, has noted that the for-profit sector of the industry too often does not live up to the hospice promise of profoundly personal and compassionate care. Also, there is a problem with fraud and abuse, about which, Byock insists, there must be institutional “zero tolerance.” In addition, the integration of palliative care within the American health system has stalled, despite demonstrating that quality care for seriously ill and dying people is both feasible and affordable.

And from my perspective — not Byock’s — the assisted suicide movement has been a body blow to the hospice movement. Partly this is because the media is so besotted with “aid in dying” propaganda that there is little room left to tell good hospice stories. But I also blame institutional hospice organizations, which pretend that assisted suicide isn’t a mortal threat to the hospice philosophy. As a consequence of this institutional cowardice, all one hears from hospice organizations about legalizing assisted suicide is the proverbial sound of silence, further diminishing the importance of the sector.

Yesterday, I posted about a Vermont bill that would allow nondoctors to prescribe death. I found out today that Oregon has similar legislation pending that would allow “providers” to lethally prescribe. SB 1003 specifies that “provider” can mean a licensed physician, a licensed physician assistant, or a licensed nurse practitioner. I wouldn’t trust a PA or NP to diagnose me with six months to live. Would you? That is not a putdown. These valuable medical professionals’ primary roles are to provide generalized care, monitor and manage chronic conditions, and provide wellness services. But they are not physicians. They receive less education and specialized training as compared with physician-certified specialists like cardiologists, oncologists, nephrologists, or neurologists. I suspect that the reason for expanding categories of eligible lethal Read More ›

The creation of the modern hospice movement was a major advance in the care for people with terminal illnesses. Alas, in recent years, hospice has entered something of a crisis, with too many facilities offering inadequate care and some patients receiving short shrift of services to which they are entitled. To get to the bottom of the problem, Wesley invited Read More ›