Matt C. Abbott
More debate on hospice care
Matt C. AbbottBy
I recently received the following e-mail:
I recently received the following e-mail:
'I am the clinical administrator of a hospice company in [city deleted]. We have extremely rigid federal regulations and would be shut down in an instance if any of the allegations you have made against hospices were true for us or any other hospice in the region. Regarding nutrition, many of our patients have gastrostomy tubes, particularly the dementia patients. Also, a nutritional assessment is performed on every patient admitted and a dietary consult is performed if they are at risk of malnutrition. We provide supplements in addition to tube feedings.
'We do not sedate patients who do not need sedation even if a POA would want it. The physician gives the orders. Every patient has the right to refuse medication. Our goal is to keep them comfortable, not in pain. Unfortunately sometimes keeping them comfortable does cause them to be sedated, but I have also witnessed a patient's respirations improving when being treated with morphine, because they became comfortable.
'It is not our intention, nor the intention of most hospices to save the government money, nor do we or most hospices kill patients. We improve their quality of life and allow them to die with some degree of dignity. If you have some facts about a particular hospice available then bring it to the attention of Medicare and the media against that hospice. Do not badmouth most of us because that is the kind of thing which prevents many from accepting the help they need.
'I do not doubt there to be some horror stories, but I would be interested in some numbers from you when you say 'most hospices kill.' Produce some facts, not second and third-hand anecdotal information. Do you even know how many hospices there are in the United States? There are approximately 4500 — so according to you most of these kill patients? I do not think so. Your intention may be good but you are guilty of irresponsible journalism.'
'It is clear that this hospice worker belongs to the group who still cling to the original standards of the hospice industry, as envisioned by Dame Cicely Saunders who created the first hospice in London, England.
'However, in this country, the first hospice was created by Florence Wald, RN, who was a professor of nursing at Yale University, and who stated for all to realize that she believes that assisted suicide and euthanasia should be available (and practiced) not only due to patients being in extreme pain, but also for 'emotional, psychological, spiritual, social and economic reasons.' Those are her words, and she was the most influential force in American hospice ever.
''Rationing scarce health care resources' is a buzz phrase that has been circulating around health care policymaking for many years. Hospice as a Medicare benefit was created in the 1980s only because pilot studies demonstrated significant savings over acute hospital care (which makes sense). Providing palliative care only, rather than curative efforts when a disease is truly terminal, makes the most sense.
'Real hospice care is a blessing for those who are suffering at the end of life; however, there are huge numbers of health care workers, physicians, nurses and social workers who believe in not only assisted suicide being made available, but also euthanasia and hospice's own brand of ending life, 'The Third Way.' That is the hospice policymaker's own terminology, and is preferred because it does not require a new law legalizing anything.
'What is this 'Third Way?' It is the misapplication of terminal sedation. Terminal sedation is appropriately applied when a patient has severe restlessness/agitation or even psychotic episodes which cannot otherwise be controlled through any means. In order to prevent further suffering and/or harm to themselves or others, terminal sedation is appropriate in those patients who meet that criteria.
'However, terminal sedation is routinely being applied in many hospices as the preferred method of controlling the timing of death, assuring death in a very short time period, and food/fluids are denied those patients while maintaining them in a medically-induced coma.
'We have had e-mails and phone calls from hospice nursing directors who are zealously pro-assisted suicide and euthanasia as well as this 'Third Way,' and who do not consider imposing terminal sedation to be 'killing.' They call it 'relieving suffering,' because they believe that life for the dying is itself intrinsically 'suffering.' Therefore, by relieving the patient of life, they are relieving them of 'suffering.'
'We have, for ten years now, received complaints from hospice nurses, chaplains, patients themselves — I received a call two months ago from a patient who was being killed/overdosed against his verbally expressed wishes — and families. Many of the family members have been nurses or physicians themselves who are not ignorant about the standards of care in health care or hospice in particular, and they uniformly state that there are many hospice staff who ignore the Advanced Directives, and even ignore the patient's clearly, verbally expressed wishes and administer morphine in particular against their will, or sedatives, or both.
'This hospice worker is naive and has no clue what is going on in other hospices. The leadership of the National Hospice and Palliative Care Organization is filled with pro-euthanasia, pro-assisted suicide personnel. In fact, the NHPCO is corporately, legally, technically directly related now to the former Euthanasia Society of America, which changed its name many times.
'It is the stated goal of the pro-euthanasia, and pro-assisted suicide organization that hospice as an industry include these medical 'treatments' as part of their range of services, and they are actively working with hospice leaders and policymakers to make sure that happens.
'We have received letters from hospice nurses who agree with [name deleted] about how hospice should be practiced; they have left the industry in their area because their hospice gave them trouble, even threatening them, when they objected to the overdosing of patients or terminal sedation when patients did not need it based on clinical conditions.
'Requesting 'numbers' is ridiculous. What hospice carrying out these imposed deaths would allow such research to occur?
'Suggesting that complaints be filed with Medicare or other regulatory authorities shows that [name deleted] is completely out of touch with the realities of today. Hundreds of such complaints have already been filed with the states (in many different states) that enforce the standards of care for the federal government/Medicare, as well as directly with Medicare's own investigators, the U.S. attorney's offices and U.S. OIG's offices, etc., as well as the local police.
'No governmental agency is enforcing the standards of care with regard to these complaints, and the answer is always the same — 'because the death of a terminally-ill patient is expected.' They don't consider it a crime, or something worth prosecuting. Only if such a crime were to occur in a private home, perpetrated by a private layperson who is not an employee of a hospice — only then will governmental prosecutors get involved.
'Hospices in many states are not inspected for several years. In California, for example, some hospices were shown not to have been inspected (not investigated, but routinely 'inspected') for eight years!
'We have had such naive assertions from good hospice workers many times over the years, and in some cases we have had victim's families write to them, and in every case, the naive hospice workers would let us know that they now believe we are correct that such imposed deaths are occurring.
'We are not saying that [name deleted] or other hospice workers in her hospice are doing this, but there are many hospices where this is definitely happening. It is part of the federal plan of ethics, formerly known as 'federal ethics,' now known as secular bioethics, which devalues the life of patients should their subjectively-determined 'quality of life' be inadequate to justify life-sustaining care, such as food, fluids or basic medical treatment.
'I am glad to know that [name deleted] and others like her who truly care about the real standards of care in hospice are still out there caring for people.'
The views expressed by RenewAmerica columnists are their own and do not necessarily reflect the position of RenewAmerica or its affiliates.
(See RenewAmerica's publishing standards.)