Assisted Suicide: Hospice Care as a Merciful Alternative
by Jack D. Gordon
President, Hospice Foundation of America [Note: Mr. Gordon served as Chairman
and CEO of HFA until his death in 2005.]
The current debate on assisted suicide is usually characterized as a choice between dying in great pain, hooked up to many machines, or calling in Dr. Kevorkian. However, there is another option called hospice care, and some 500,000 persons (out of approximately 2 million deaths) died in hospice care in the United States in 1998. Many commentators on assisted suicide talk about better ways to treat the terminally ill, yet they completely ignore the hospice movement, which accomplishes that very goal.
The modern hospice movement, at its start in the early ‘70’s, was almost exclusively for those with terminal cancer. Medical advances had moved the place of death for most people from their homes to the technological chamber of horrors which is the modern hospital. Wouldn’t it be better, hospice pioneers reasoned, for people to die in familiar surroundings, free of pain and in control of their faculties?
That option would require the patient to be served by a team consisting not only of the attending doctor, but also the hospice physician, who is an expert in pain control, and a social worker, who helps the patient as well as the family come to terms with the situation. This hospice team also includes a nurse and a nurse’s aide to teach the family how to best take care of the patient; clergy, if desired; and volunteers who spend time being helpful and also provide some respite for the family.
And that’s what hospice does: It treats the patient and not the disease. When medicine can no longer add days or months to life, hospice can add life to the remaining days. In recent polls, people were asked to state their concerns about end-of-life care. Overwhelmingly, the three most frequent responses were a lack of control over their situation; dying in pain; and dying alone. Through its interdisciplinary approach, with the patient at the center of care, hospice helps conquer these primary concerns. Hospice is, first and foremost, an expression of patient autonomy, which is one reason so many physicians know so little about it and refrain from referring patients until the very last minute. That reluctance is also related to the financial rewards for continued treatment. As Hillaire Belloc once rhymed, “the doctors stood in line to collect their fees, and said there is no cure for this disease.”
While much concern has been voiced over the possibility that assisted suicide will be used to save expenses, the real economic incentive that needs to be faced is from excessive treatment that does nothing for the patient but makes lots of money for the doctors, hospitals and providers of ancillary services. In a study that the Hospice Foundation of America funded at the University of South Florida School of Medicine, cancer patients who continued aggressive treatment after their cancer had metastasized actually lived, on average, one day less than those who chose hospice care. That seems reasonable, since the hospice patients weren’t burned by radiation, poisoned by chemotherapy (a nicer-sounding word) or cut up by surgery. But there were no fees to speak of for the oncologists, radiologists or surgeons, and very few hospital stays.
Some of the proponents of assisted suicide always say there are persons hospice cannot help, and therefore assisted suicide is the answer. But how do we know that hospice care, once experienced, would not be preferred by the dying person and the family? Would proponents modify their proposal to say that assisted suicide cannot be considered by a physician unless the patient has been in hospice care for at least a month or six weeks? A reasonable period of time is necessary if pain is to be brought under control and the patient and family are to be prepared for the inevitable death and its aftermath. That would at least give the patient an informed choice.
