Matt C. Abbott
June 20, 2005
Hospice nurse: I don't kill!
By Matt C. Abbott

In response to a previous column of mine on hospice care, I received the following (edited) e-mail from hospice nurse Laurie Walton of Davie, Florida:

"I am sick and tired of the accusations that hospice facilities kill patients. We are not in the business of euthanasia. We are sick of this kind of rhetoric which instills fear in those who are suffering end-of-life illnesses and are afraid to accept relief from pain because of these accusations. They think that by accepting the care we offer we are hastening death. Odd. We actually discharge some patients for extended prognosis.

"I have been a hospice nurse for 13 plus years. I have not once, not ever, caused a death. I have had to educate patients and families about pain and symptom management, ad nauseam. We follow the World Health Organization pyramid of pain relief which begins with Tylenol, the generic of which is acetaminophen. We follow the guidelines even with that, which are that it cannot exceed 4000 mg (4 grams) in 24 hours because of liver damage. We titrate the Class II pain relief medications carefully, and it should be known that we take into account many factors such as age, size of patient and prior use of pain relieving meds.

"As the body systems fail, the body is less and less able to tolerate fluids. In fact, in the dying process, the cardiovascular system weakens resulting in fluids building in the lungs. It is natural. Adding fluids at this point compounds fluid build-up and results in greater discomfort. What is not natural is to spend dying hours and days hooked up to machines with needles sticking the patient, not to mention cold, impersonal hospital rooms or wards, frequently in ICU, with limited visitation.

"Many of our patients want to be cared for in their own homes, and we can do this. Some hospices, such as ours, can also offer inpatient care in our own facilities if it is preferred or symptoms require it. We can offer inpatient respite care for sick or stressed out caregivers for limited time frames, and we can offer our services to nursing home and retirement home patients.

"We are about palliation of symptoms, care, comfort and relief. We are an interdisciplinary team approach encompassing spiritual as well as physical and psycho-social needs. We are realistic about end of life, unlike some people who profess to be so holy and yet fear death. It never ceases to amaze me how many Catholics are frightened of death, despite professing such faith.

"The care I give my patients is a constant expiation for the lack of care my own mother received in her terminal illness. There was no hospice available then. The doctors were afraid, and some still are, of palliation. My mother suffered terribly at home with me, her very useless caregiver. She was very accepting of her terminal condition and wanted nothing extraordinary done. She was very, very clear about that.

"We have a Catholic Hospice here. We have several hospices. The Catholic Hospice won an award last year. Maybe you should look into them. They are suspect. They are hospice."

Ron Panzer, president of Hospice Patients Alliance, responded to Walton's e-mail as follows (edited):

"We at Hospice Patients Alliance have the greatest respect for what the hospices have stood for over the years and the wonderful reputation they have earned through hard work, relieving the often severe symptoms that accompany end-stage terminal illnesses. I have worked in hospice with the dying and still work with hospice patients and their families. I have never hastened a death of a patient, and some of the most dedicated professionals I know have been hospice staff.

"Hospice has been about relieving the symptoms in the dying and allowing a death in its own natural timing. However, we regularly receive complaints from family members, often professionals, doctors, nurses, attorneys and others, about unnecessary dosages of morphine given to patients with no pain issues, or sedatives given against the wishes of the patient. There are cases where medical examiners have officially determined causes of death as unnecessary dosages of morphine within the hospice setting. There are reports of nurses and doctors killing patients in various settings.

"Nurses have witnessed such hastened deaths. And, I have been told by hospice nurses that they will hasten death in patients who request to be sedated and dehydrated to death, even though their terminal illness was not taking them at that time. I have also been told by hospice nurses that there have been times when they, or physicians, would 'push' a patient over into death (even if not requested) through excess medications if the patient was, in their view, suffering from a poor quality of life. There are medical journal articles that conclusively report physicians will increase the dosage of morphine in certain situations, even if the patient does not have uncontrolled pain, and where the result is clearly death to the patient.

"It is only an uninformed nurse who could possibly be unaware that the euthanasia movement has set its sights on the hospice industry as the vehicle to further their goal of legalizing euthanasia and assisted suicide. The euthanasia advocates prominently post on their websites their position that terminal sedation, the sedating of a person permanently until death occurs, is a preferred method of hastening death because the public may not understand it or perceive it as 'assisted suicide' or euthanasia (though it is).

"The patient is placed into a medically induced coma, is asleep, and appears to die 'peacefully.' However, it is the actions of the hospice staff that directly result in the death of the patient, rather than the patient's own terminal illness. In other words, the patient is killed.

"Those who kill through the misuse of terminal sedation do not admit that they are killing. They prefer to say that the patient is 'allowed' to die. However, you, I or anyone, with or without a terminal illness, would die under these circumstances. Saying the patient is 'allowed' to die is just as accurate as saying that those prisoners who were gassed in the Concentration camps were 'allowed' to die.

"Misuse of terminal sedation is widespread in some hospices, or with some staff. We have heard from enough families, nurses, staff, and even hospice administrators and nursing directors that these practices are occurring. Patients are given morphine sometimes when they have absolutely no clinical need for it. Given in large dosages, it is truly a powerful medication: miraculous when there is severe pain and diabolical when there is none.

"Just because this hospice nurse does not hasten death, does not mean it never happens. And for that nurse to be 'sick' of hearing about it is absurd. There are literally thousands and thousands of articles about the wonders of hospice. The federal and state governments promote hospice as a way of providing better end-of-life care, as they should. However, let's not be naive. The federal and state government would never have promoted hospice if they were not significant cost savings to the federal and state budgets. From the early years of hospice as a Medicare benefit, in the 1980s, through the 1990s and beyond, studies have been done verifying the cost savings of hospice care over traditional aggressive acute hospital care.

"Hospices have been very clever and well-organized in promoting itself as an industry. In fact, the hospitals and nursing homes have never come close to the PR machine that hospice employs. Whether newspaper ads, radio spots, TV ads, article after article on the net, or in the press, hospice is portrayed as a lily-white, pristine and pure industry unlike any other known to mankind throughout history.

"Hospices, mostly nonprofit corporations, use the TV, radio and print media to help fundraise for their charitable mission, thereby creating a business and philanthropic relationship of 'partnering' with the media. What media outlet is going to not only accept hospice money for advertising, raise money together in fundraising drives, and then turn around and print articles that show the hospice in a bad light? None!

"Hospice staff are portrayed uniquely as "angels," as if the nurses and doctors who work to assist mothers at childbirth are not worthy of such praise? Or the doctors and nurses who work to perform virtual miracles in the surgical suites of our nation's hospitals? Or the nurses and doctors who work tirelessly to care for the millions of patients? Why are hospice staff singled out for this singularly unique praise and are immune from having their faults exposed? It is because the industry is being promoted by government and the health care industry as the preferred way of dealing with the dying.

"Yet, the agenda of those who are promoting hospice (the hospice lobbyists) is to include the non-dying in the mix of patients who are eligible for entry into hospice. Who are the non-dying that are being targeted? They are the severely disabled, the chronically ill and very elderly. Initiatives have been pushed forward by hospice industry lobbyists in California and other states specifically targeting these populations for entry into hospice. Though these initiatives have failed, the agenda is evident: get more patients into hospice offering them 'comfort' care and saving billions of dollars for the state and federal budgets. Hospice as an industry gets more revenue through a greater 'cut' of the patient population, government saves.

"The combination of managed care in health care, the profit motive for the for-profit hospice chains increasingly entering the hospice arena of care, and the agenda of the euthanasia advocates is creating an evil confluence of power to force the vulnerable into hospice and hasten their death within that setting....

"There are virtually no articles in the mainstream media about hospice killings of patients, though it is much more common than popularly known. Even the killing of Terri Schiavo was never mentioned in the media as a hospice killing, though that is what it was. Mrs. Schiavo died of dehydration; she was intentionally deprived of fluids to cause death in the hospice. That is a killing. And the method is one that is used over and over again in some hospices.

"Not all hospices do these things, and not all hospice staff do these things. They could never have the generally good reputation that they do have if they did. However, when it happens to any patient, the family and patient generally have no idea that this could be happening until it is too late. And then, hospice staff who manipulated the medications to cause death (by over sedating the patient, by overdosing the patient with opioids such as morphine) mislead the family by telling them that the patient died of the terminal illness (when that is absolutely untrue). We hear about these deaths over and over, year after year.

"Some hospice nurses are simply unaware that the dosages of morphine given, if unneeded, when there is little or no pain, create the same symptoms of the active phase of dying as a terminal illness: slower respirations, decreased blood pressure, coma and death. They do not recognize that they are hastening death. However, there are others who do know what they are doing. Families of victims report hearing nurses say, 'I am just like Jack Kevorkian, only I use morphine, and I get away with it every time.'

"Families who report such over dosages of patients are routinely rebuffed by the police, the prosecutors, the staff of the hospice and any other government agency they may contact. Why? Because a death in a hospice is an 'expected death.' Prosecutors recognize that the "policy" set from high up in the national policymaking circles, is that patients will die in hospice, even hastened deaths, and that nothing is to be done about these killings. Prosecutorial discretion is exercised throughout the USA to block prosecution in such cases, and any doctor or prosecutor who states that they are unaware that such killings occur is a liar.

"We receive periodic responses from defensive hospice nurses, like the one who wrote you, saying they are upset to hear about hospice killings because they don't do it. Yet, they are simply naive. We have too many reports about these killings to remain silent. If we do not speak up, who will? Reports have gone to the National Right to Life Committee and other advocacy organizations about such killings. It is not due to a lack of understanding of the dying process, nor is it due to families being 'afraid' of death. We understand that we all will die. We understand that dying is not always 'pretty.' And hospice is a much appreciated service when it works to relieve the sometimes difficult symptoms that occur at the end of life.

"However, there is a big difference between allowing a natural death in its own timing from the terminal illness, and hastening it through a variety of means, including intentional dehydration, along with unrequested sedation or unrequested, unneeded over dosages of morphine. Hospice is welcome when it serves the patients and honors their wishes for relief from pain and suffering.

"Organizations such as Hospice for Choices (formerly Hospice for Hemlock), and Compassion in Dying, End-of-Life Choices (formerly the Hemlock Society) have specifically entered into the end-of-life arena working hard to influence hospice as an industry to make it the place to commit euthanasia (imposing death) or 'assisting' patients to death. Anyone who does not recognize the threat to the original mission of hospice and does not recognize that there are many euthanasia advocates already working in the industry doing what they want to do is simply naive or uninformed."

© Matt C. Abbott

 

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Matt C. Abbott

Matt C. Abbott is a Catholic commentator with a Bachelor of Arts degree in Communication, Media and Theatre from Northeastern Illinois University. He has been interviewed on MSNBC, NPR and WLS-TV in Chicago, and has been quoted in The New York Times and the Chicago Tribune. He can be reached at mattcabbott@gmail.com.

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