Human Exceptionalism

Caplan & Smith on Improving Hospice

The noted bioethicist Arthur Caplan and I tend to disagree about issues. For example, he reluctantly supports the Oregon assisted suicide law and I adamantly oppose it.

That issue tends to suck all oxygen from the room. But there are other things that need to be discussed about end-of-life care.

Toward that end, we came together and co-authored a column in USAToday urging a reform that could drastically increase hospice participation.

As things now stand, a patient who chooses hospice has to forego curative and life-extending treatment. For some, that is akin to saying, “Abandon hope all ye who enter here.”

We urge ending that “awful choice” to increase hope. From, “Give Terminally Ill Patients Both Hope and Hospice:” 

For many, that is akin to giving up all hope, and thus they delay entering hospice until it is too late to benefit from it. But hospice is all about realistic hope: hope of not being in pain; hope of being able to enjoy family until the very end; hope of maintaining a good quality of life throughout the dying process; hope of dying at home surrounded by those you love.

We quote the splendid hospice physician, Ira Byock, in support of our proposal:

Hospice expert Ira Byock, author of The Best Care Possible, concurs with the change we suggest. He told us: “A third of all U.S. hospice patients die within a week of being admitted. Thus, because of the ‘terrible choice’ Medicare rules impose, hospice is not doing end-of-life care as much as brink-of-death care.”

We conclude:

Whatever happens with the assisted suicide debate, the more attractive we make hospice to those in need, the more they and their families will benefit from this truly beneficent approach to caring for the dying.

This is not a “compromise” about assisted suicide. It is about improving care. It is about basic decency and respect for the dying.  

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