I think that life is like Bob Dylan sang "he not busy being born is busy dying". When patients complain that they are getting old I remind them that the only alternative is not so great.
Hospice care can provide spiritual and physical comfort to the dying. It is for patients who have a terminal condition and are believed to have 6 months or less of life left. Enrollment requires that the patient not be seeking curative therapy for their condition. A large focus is on pain control.
Some doctors are hesitant to enroll a patient because of not wanting to guarantee that the patient will expire within the six month period. There is no penalty to the patient or the physician if the patient lives longer.
The hospice company employs social workers, chaplains, nurses, nurse aids, and a medical director to facilitate the transition of the patient to the afterlife. They can provide assistance to the patient as well as the family in their own home or in an extended care facility.
Elisabeth Kubler-Ross, in her seminal book "On Death and Dying", taught us the five stages of dying. They are denial, anger, bargaining, depression, and acceptance.
Clearly, a patient in the fifth stage is ready for and can benefit from hospice care. The problem sometimes occurs in the other stages and that is where it is critical to know the policies and philosophies of the individual hospice company and its medical director.
Most patients in hospice choose to have their personal physician remain in charge of their overall care. Some doctors choose to relinquish complete care over to the hospice's medical director. Some request that the medical director take care of pain and comfort issues only while other doctors use the hospice physician for consultations only if difficulties arise.
Some medical directors take a more aggressive, hands-on approach and will overrule the patient's doctor treatment decisions if a disagreement exists on how to best treat a specific problem. This is only appropriate when a patient is not receiving adequate symptom relief and the personal physician is unwilling to modify the current treatment.
While the patient has the right to withdraw from hospice at any time for any reason, the hospice has the right to withdraw from the patient's care for certain reasons. Some reasons are required by regulations and others are company specific.
All hospices will revoke a patient's care if curative care for the terminal condition is sought. Services can be restored should the patient later on abandon these efforts.
Some hospices will revoke a patient's care if the patient chooses to go the hospital for any reason. I strongly disagree with this position. There is no reason not to aggressively treat an unrelated condition if it will improve or prolong the quality of someone's life.
For example, if a patient has terminal brain cancer and is having a good quality of life, there is no reason not to consider hospitalization to manage unrelated conditions such as pneumonias or heart problems. Even surgery might be appropriate in certain circumstances.
Some hospices require a patient sign a statement that they do not want to be intubated, on a ventilator or have CPR performed on them. I strongly disagree with this position as well. Part of the service of hospice is to assist the patient in the dying process.
Not all patients are in the stage of acceptance when hospice services are appropriate. Hopefully, with counseling and time a patient can be moved through all the stages before death occurs. But to deny hospice care to someone because they are not ready to formerly sign a "Do Not Resuscitate" order seems almost cold-hearted.
Patients in the earlier stages of dying often need the spiritual and physical help that hospice can provide more than those in the later stages. A hospice should assist patients in the process of accepting a DNR order. This process may take weeks or months and in some patients it may never occur.
If you or a loved one is a potential hospice candidate, consult with the patient's doctor. If hospice is deemed appropriate, consult with several hospice providers to find the one that best meets your needs and is in sync with your philosophy on caring for the terminally ill.
