Hospice Meets End of Life Needs

February 6, 2015

By: Carolynn Peterson, Executive Director
Hospice of the Foothills

Aid-in-dying, also known as physician assisted suicide, is an issue that regularly forces itself into our collective consciousness. And so it should. After all, what could be more personal and relevant to all of us than the question of how we choose to die when our time, inevitably, comes? For years, the ” right-to-die movement” was most associated with Jack Kevorkian, the Michigan pathologist who participated in dozens of physician-assisted suicides, one of which led to a conviction of second-degree murder.

Brittany Maynard, the 29-year-old newlywed who was diagnosed with brain cancer and died Nov. 1, 2014 after taking doctor-prescribed barbiturates in Oregon, where the practice is legal, once again propelled the debate into national headlines. She advocated for similar Oregon-style legislation elsewhere. Now California joins three other states and Washington, D.C., in proposing “Death with Dignity” legislation modeled after the Oregon law.

With last week’s introduction of the California bill, “The End-of-Life Options Act” (SB 128), Californians will again have ample opportunity to ponder what has long been considered a taboo subject. If the bill fails the issue will likely go to the voters as a measure on the 2016 ballot. Clearly, the issue is not going away any time soon

Unfortunately, passionate rhetoric sometimes obscures fundamental truths. The bill’s name suggests that in some way those at the end of life either lack options or those options are deficient. In reality, the terminally ill do have a place to turn. In fact, more than 1.5 million Americans do every year – it’s called hospice. Today’s hospice doctors and nurses have the tools to relieve much of the suffering from terminal illnesses. Hospice is skilled in a variety of multi-disciplinary approaches including aggressive symptom control to relieve unnecessary pain consistent with a patient’s expressed wishes or values. Hospice comprehensively addresses the medical, psychosocial, spiritual and comfort needs of the patient and their family.

The spotlight on aid-in-dying clouds the availability of comprehensive end-of-life hospice care that is available to all. Although the Medicare Hospice Benefit provides six months hospice care to all terminally ill patients who qualify, the program remains underutilized. Too many patients only come to hospice in the last weeks of life. At hospice, “If I’d only known about you sooner,” is the comment most often heard from patients and their families.

There are many compelling practical reasons beyond religion, values, fear, or ethics not to expand physician aid-in-dying but to focus instead on expanding physician and other clinician-assisted hospice and palliative-care approaches. Many hospices across the country are struggling as a result of increased compliance and regulatory expenses in addition to the sequestration cuts for Medicare providers that went into effect on April 1, 2013, reducing reimbursement by 2% for ten years.

Hospices are uniquely qualified to address the needs of the dying. Hospice can help patients remain in control and die at home. The goal of hospice is to improve quality of life in the patient’s last months, focusing on comfort care, control of pain, and symptom management. In addition to caring for the patient, hospice also provides instruction, assistance, and support for the family. The unit of care is the patient and the family.

Seeking a prescription for life-ending medication should not be the first choice for patients seeking to relieve fears, pain, or symptoms of a terminal illness. Although hospice patients forgo curative treatments, hospice isn’t about giving up. Choosing hospice is choosing to live life to the fullest.

Patients already have options. The focus of the current debate should be more about the ready availability of patient-centered, comprehensive and appropriate end-of-life hospice care than about hastening someone’s death. Patients at the end of life who get the best quality hospice palliative care are comfortable, live longer, and are often able to spend time, usually at home, with their families. As Cicely Saunders, the British founder of the modern hospice movement declared, “Last days need not be lost days.”

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