Hospice is about living, not dying. More precisely, hospice supports life with dignity for its patients and offers invaluable social and emotional support for patients’ families.
The foundational moral values of hospice are antithetical to everything the assisted-suicide movement represents. Hospice was founded by the great medical humanitarian Dame Cicely Saunders in the late 1960s as a reform movement to bring the care of the dying out of isolated hospitals and into patients’ homes or non-institutional local care facilities. As Saunders told me in a 1998 interview, “I realized that we needed not only better pain control [in the care of the dying] but better overall care. People needed the space to be themselves. I coined the term ‘total pain’ from my understanding that dying people have physical, spiritual, psychological, and social pain that must be treated.”
Treating “total pain” takes time, patience, love, and an unalterable commitment to the inherent value of each patient’s life—a devotion so strong that good hospice professionals continue to embrace that truth even if the patient can’t. That is why Saunders included suicide prevention as a crucial hospice service alongside the provision of effective pain control and needed social services. It also explains Saunders’s adamant opposition to legalizing assisted suicide: She viewed it as a crass denial of dying patients’ intrinsic human dignity.
As a hospice volunteer in the 1990s, I was strictly instructed to notify the multidisciplinary team whenever a patient expressed the desire to die immediately or commit suicide, so that caregivers could intervene and take corrective countermeasures. This isn’t a fool’s errand. Multiple studies have shown that terminally ill patients who are suicidal but don’t kill themselves are often happy later to be alive.
Hospice was once popular in the media. Now, assisted suicide gets most of the attention—as evidenced by the Brittany Maynard feeding frenzy. Indeed, editorials favoring assisted suicide often ignore the tremendous good hospice provides or even damn the sector with the faintest of praise.
But the attention and praise assisted suicide currently enjoys can be turned in favor of its opposite. The false meme that suicide is somehow “dignified” is an opening for the hospice movement to educate the public about what it offers the dying and their families. It is an opportunity to contrast hospice’s true compassion for those who suffer with assisted suicide’s method of patient “care”: eliminating the sufferer as a means of ending his suffering. As palliative care expert (and self-described political progressive) Dr. Ira Byock recently wrote in the Los Angeles Times, “deliberately ending the lives of ill people represents a socially erosive response to basic human needs.” No kidding. He urges instead the passage of the “Safe Dying Act,” which would step up our commitment to caring for the dying through better medical training and improved regulation, including freeing patients from the requirement that they choose between continuing treatment and entering hospice.
Unlike individual advocates like Byock, the organized hospice movement in recent years has shrunk from the challenge presented to it by the aggressive push for assisted suicide. Perhaps movement administrators are afraid of controversy, losing donations, or appearing judgmental. Whatever the cause or causes, rather than rebut the noxious notion that suicide is “dignified”—which implies that living until natural death is somehow undignified—they have remained largely silent.
For example, November is National Homecare and Hospice Month. Did you hear about it in 2014? Probably not. It didn’t receive much media attention.
Even though the Maynard assisted-suicide controversy was then front-page news (and constituted an assault on hospice philosophy), providing an opportunity for hospice to gain much-needed attention as the true upholder of dignity in dying, the National Organization for Homecare and Hospice uttered not a word about it in their hospice promotional materials. This abdication of ethical responsibility from the hospice sector presents an existential threat to everything that Dame Cicely Saunders created. When suicide proponents boast that most of the people who have died by assisted suicide in Oregon were also in hospice (not Maynard, by the way; she rejected that option) and the hospice sector fails to note that suicide prevention is as essential to proper care for dying patients as morphine is for pain, it abandons the dying to those who would transform hospice into hemlock.
If that happens, hospice won’t be about living anymore. It will just be a place where people go to die.