 | Tom Welk
DMin is Director of Pastoral Care & Professional Education at Harry Hynes Memorial Hospice. He also teaches at the University of Kansas School of Medicine-Wichita. He has certification with the American Association of Pastoral Counselors in Clinical Pastoral Education. His memberships include Park Ridge Center for Study of Health, Faith, and Ethics, and St. Louis University Center for Health Care Ethics, Charter Board Member Kansas Health Ethics, Inc., and Ethics Committee Member for National Hospice Organization. He has received the President's Award of Excellence for Public and Community Awareness, for the "Dying Well" project from The National Hospice Organization. Tom's group presentations include: Association of Kansas Hospices, Midwest Congress on Aging, and Kansas Health Ethics Conference. Tom Welk can be contacted by fax at (316) 265-6066, by e-mail at: twelk@hynesmemorial.org, or at his office at (316)219-1791. |
Hospice
2003-06-01 16:04:00
Referred to hospice
ANSWER: For many in our society, the words "referred to hospice" are ominous. It frequently is understood as a death sentence. Unfortunately, hospice is too often associated with death. More on this later. First, let me answer the more technical question: "What does it mean to be referred to hospice?" Fundamentally, it means that the individual can realistically expect death to occur within six months or less. In order to receive the care of a hospice program, a doctor must write an admission order. Medicare and Medicaid require that two physicians (the patient's primary physician and a hospice medical director) certify that in their best reasonable medical judgment the patient has a prognosis of six months or less. Being referred to hospice also means that curative treatment is no longer seen as likely to have a positive outcome. The medical interventions extended to patients under the care of hospice are palliative, i.e., comfort measures for the control of pain and management of troublesome symptoms (shortness of breath, nausea, diarrhea, etc.). The change from curative to comfort medical care can be a difficult one. Too often terminal patients feel they have been abandoned by the medical community. Even the expression "There is nothing more we can do," though meant to convey that curative interventions are futile, frequently is interpreted by patients to mean they will no longer receive any medical care. For that reason, they must be helped to clearly understand that they will not be abandoned, but that now the focus of medical care will be for comfort rather than cure. This will help dispel the notion that coming under the care of hospice is a death sentence. Indeed, often hospice patients tend to live longer. There may be various reasons for this: 1) Physical functioning is not being compromised by the possibly debilitating side effects of curative treatment; 2) emotional stress is relieved; 3) support given to family members is translated into support for the patient. Every human being has an instinct for survival. It is natural for us to want to live as long as possible and modern medicine has dramatically extended the average life span. The challenge that confronts us is to balance the quantity of our life with its quality. What is more important? How long we live? Or, how we live long? In terms of medical interventions, we will obviously avail ourselves of whatever curative interventions that are clearly beneficial. When it cannot be reasonably expected that the benefit will outweigh the undesirable side effects (burdens) of the treatment, no matter how sophisticated the intervention, then it is time to conclude that enough is enough. When the burdens outweigh the benefits we are no longer doing for the patient, but to the patient. Sorting out these questions can be a difficult and painful process. But when it is determined that curative treatment is not likely to result in a positive outcome, then it is time to refer to hospice. With the support provided by a good hospice program, the patient and his/her loved ones can take advantage of the time that is left and live each minute of that time as fully and as well as possible. Being referred to hospice is not a "death sentence." Indeed, it is a prescription for living till the moment of death.
