Give Terminally Ill Patients Both Hope and Hospice

Terminally ill brain cancer patient Brittany Maynard’s death by prescribed lethal overdose — legal in Oregon— made headlines. Her campaign to legalize assisted suicide — or as some prefer, “aid in dying” — sparked increased debate of the best ways to care for the terminally ill.

Most of the attention has focused on hastening death, a volatile topic about which people of goodwill — including this article’s authors — have differing views. (Caplan supports assisted suicide; Smith does not.)

Rather than shout at each other, both sides of the assisted suicide divide should get enthusiastically behind this health care change: Allow the terminally ill to enter hospice care without having to give up life-extending or curative treatments.

As matters stand, the law requires patients considering hospice to make an awful choice. In exchange for insurance paying for hospice care — which focuses on pain control, symptom management and social support — the patient must forgo all other forms of treatment.

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.

Making people choose between hope and hospice is both cruel and unnecessary. In the United Kingdom, for example, patients can enter hospice and still receive that last ditch round of chemotherapy if that is what they want. Not surprisingly, hospice participation in theU.K. is historically higher than here.

Interestingly, most hospice patients get so much benefit out of hospice they don’t pursue painful life-extending care. Even so, knowing they can makes it far easier to make the hospice choice.

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.”

That needs to change. If we really care about death with dignity, we will stop making dying patients choose between hope and comfort when they can easily — and affordably — have both.

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.