I was waiting for this. A couple of years ago I passed a hospice facility in Naples and it occurred to me that the only thing that keeps it a place where people in the stage of dying preserve their intrinsic human dignity is the attitude of their care-givers. The commitment and qualifications of the hospice workers to the dignity of their patients is what makes the hospice a place of light and comfort for them and their families in often very difficult circumstances.
But what happens if the attitude changes? What happens if the State intervenes with such things as Obamacare which inevitability will be poorly run and thus force a utilitarian calculus on end of life decisions? Will there be pressure to convert the hospice facilities to places where we hasten the death of the sick? All it would take is a change of attitude, a jettisoning of the respect for the inherent dignity of life into the perverted but increasing prevalent notion that the best way to deal with the dying is to hasten their death.
It looks as if the assault on the hospice philosophy has begun. Wesley Smith in the most recent issue of First Things writes about it below.
Wesley J. Smith
Hospice is about living, not dying. More precisely, hospice supports life with dignity for its patients and offers invaluable social and emotional support for patients’ families.
The foundational moral values of hospice are antithetical to everything the assisted-suicide movement represents. Hospice was founded by the great medical humanitarian Dame Cicely Saunders in the late 1960s as a reform movement to bring the care of the dying out of isolated hospitals and into patients’ homes or non-institutional local care facilities. As Saunders told me in a 1998 interview, “I realized that we needed not only better pain control [in the care of the dying] but better overall care. People needed the space to be themselves. I coined the term ‘total pain’ from my understanding that dying people have physical, spiritual, psychological, and social pain that must be treated.”
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Hospice was once popular in the media. Now, assisted suicide gets most of the attention—as evidenced by the Brittany Maynard feeding frenzy. Indeed, editorials favoring assisted suicide often ignore the tremendous good hospice provides or even damn the sector with the faintest of praise.
But the attention and praise assisted suicide currently enjoys can be turned in favor of its opposite. The false meme that suicide is somehow “dignified” is an opening for the hospice movement to educate the public about what it offers the dying and their families. It is an opportunity to contrast hospice’s true compassion for those who suffer with assisted suicide’s method of patient “care”: eliminating the sufferer as a means of ending his suffering. As palliative care expert (and self-described political progressive) Dr. Ira Byock recently wrote in the Los Angeles Times, “deliberately ending the lives of ill people represents a socially erosive response to basic human needs.” No kidding. He urges instead the passage of the “Safe Dying Act,” which would step up our commitment to caring for the dying through better medical training and improved regulation, including freeing patients from the requirement that they choose between continuing treatment and entering hospice.
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Read the entire article on the First Things website.
Please see hospicepatients.org for the ORIGINAL purpose and methods used in hospice in the 1980’s before Medicare began to impact finances and incentivize neglect of true palliative care in the 1990’s. Please use that site to try to find a hospice which honors the original purpose for patient and family.
As a physician who trained in hospice in the 1980’s as a volunteer before going to a Catholic medical school, and now an Eastern Orthodox physician, I would only say that tragically in my office, medical society, and personal life I have learned it is a rare hospice which deals with patients as originally envisioned or as consistent with the Eastern Orthodox or Roman Catholic way much less the Hippocratic Oath.
Please read the cautionary tales on the website under Euthanasia. Please learn on the site what questions to ask to understand what your loved one will actually go through and why. The goal of original hospice was to keep a person as comfortable and fully present and him/herself as possible by whatever means was appropriate so he or she could with dignity and a clear mind reconcile with family, oneself and with God.
That was “palliative care” then and as it should be. Now starvation and dehydration (which are quite painful) may be masked by heavy pain med sedation so that the person is quiet while being killed early essentially.
You may see a family joking with staff in a party atmosphere and not “with” the immobile and unresponsive patient at all. It is all quite bizarre, deceptive, and not loving, respectful and filled with dignity as intended.
Our goal is to restore hospice to its rightful function. Not to have truly comforting medications denied due to expense and called “extraordinary measures” when previously it would have simply been part of good care to optimize how the patient feels and can function. I am always grateful when someone has had a good experience with hospice recently; they are blessed.
Please see this website and fight for your loved one to receive the “original” hospice care, hospicepatients.org. I have no involvement with it, just somber appreciation.
Dr. Cooper,
Thanks for the insight. I am my wife’s business manager and it is rather striking how much and how rapidly medicine is changing. The general “health care consumer” has no idea. One of the doctor’s my wife works with likes to point out the differences between our system and England’s (where he worked for 20 years). He likes to go down the inpatient list and explain how this or that person would simply be dead in England. He also talks about the ways in which our system is rapidly conforming to that rationed model.
I am rather pessimistic anything can be done about it however. Too many factors are contributing to the direction we are headed…
I highly recommend Atul Gwande’s Being Mortal: Medicine and What Matters in the End:
A truly compassionate, gifted man and physician.
I had to come back here to add that my mother, at age 86, dying of congestive heart failure and a defective heart valve, had already signed a DNR when surgeons, who had literally pioneered a fantastic technique referred to as Transcatheter Aortic Valve Replacement (TAVR) (threading a collapsed valve through an artery in the groin to the damaged valve) offered her “the chance” for this procedure. I held her hand, as she quietly, between her 6-7 respirations per minute, and the morphine drip to stop the chest pains of infarction, smiled and nodded, “no.” By 4:00 pm on Great and Holy Friday, she was moved upstairs into in-hospital hospice, a single room with a large window overlooking the Pacific Ocean, receiving fluids & light pain meds only. When I returned from The Matins of Great and Holy Saturday, the nurses had bathed her and given her a clean gown. She smiled but could no longer speak, grasping our hands and wracked with spasms. I placed her iPod next to her and played the recorded services of Holy Week from the Holy Transfiguration Monastery in Ellwood City, PA, and I said, “Do you recognize the voice of the priest? It’s Fr. John Jillions,” whose voice she knew well. She smiled and fell into a calm sleep. The nurses quietly checked on her, adjusted her position, wiped her forehead, asked of the needs of everyone in the room, but did not interfere. By the grace of our loving God, she fell asleep in the Lord at exactly noon on Great and Holy Saturday, to participate in the glorious Resurrection of our Lord. This, I believe, was the Christian ending for which we pray, and a successful week of the efficacy of hospice.
Thank you for this testimony. “a place of brightness, a place of refreshment, a place of repose…” for your mother do I pray…
Thank you for your devotion to God’s principles! Many of us suffer from moral injury after witnessing less than compassionate care…I have become petrified of Western medicine.