 | 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
2003-07-01 16:09:00
Hospice or hospital?
ANSWER: Framing the question as hospice over other medical care appears to set this up on a competitive basis. Understanding the role of each aspect of care indicates that it is not a question of either or (i.e., either hospice or other medical care). Hospitalization is the appropriate way to care for someone with an acute illness or injury when there is reasonable expectation that the aggressive curative intervention will restore the individual to beneficial physical functioning. In other words, hospitals are places to care for individuals who are considered sick rather than imminently dying. Hospitals can point with pride to the high degree of success achieved in saving lives. Prior to the existence of the modern hospital many individuals died at a relatively young age. Yet, at the same time we must acknowledge that despite the many successes that have enabled the life span of most people to be dramatically increased, mortality is still a part of human existence. Eventually we will all become incurable/unfixable despite all the marvelous curative interventions of modern medicine. At that point we are no longer to be considered as being sick. Once it is no longer reasonable to expect a positive outcome of even the most sophisticated curative intervention, then we have entered the dying role. The focus of the medical care must now also change to a palliative or comfort mode. In the dying role individuals still have much living to do, such as tying up loose ends and taking care of unfinished business. Among other things this involves saying good bye, making amends when necessary, and indicating to loved ones how important they have been and how much they will be missed. It is with the support of hospice that this will most readily take place. Patients who are in uncontrolled pain and dealing with troublesome symptoms (such as vomiting, nausea, shortness of breath, etc.) will not be able to engage in addressing psychosocial/spiritual issues that if left unmet can also be a great source of suffering. The hospice interdisciplinary team (hospice physician, nurses, health care aides, chaplains, volunteers) is there to provide whatever support is needed, both for the patient and the family. Moving from the sick to the dying role is much more difficult today than it was before the advent of modern medicine (approximately 60 years ago). Today we wrestle with the question of when it is appropriate to stop curative intervention because there always seems to be "something more that can be tried." However, we must honestly ask ourselves, "Are we doing to a patient or for a patient?" When does the curative intervention become more burdensome than beneficial? If that is the case then hospice is the most appropriate program to provide care. The role of nursing home care is another story. Individuals residing in a nursing home (also called a long term care facility) are not seen as imminently dying, but generally do need more support to meet the needs of everyday living. If perchance the nursing home resident is considered to be in the dying role (in a doctor's assessment having a prognosis of six months or less) then hospice can also be involved in providing care in this setting. Finally, is choosing hospice tantamount to giving up? This question implies that entering a hospice program is a death sentence, and if hospice is not involved then the patient would live longer. Yes, it may be possible to live longer by continuing to avail oneself of aggressive curative care, but what kind of "living" will it be? There is no doubt that some curative interventions have very difficult and challenging side effects. The important issue is not always how long we live, but also how we live long. To sum up: Hospitals, nursing homes, hospice --- each one has its appropriate role in providing care on the journey of life. They are not to be seen as in competition with one another, but to complement one another to meet different needs on different parts of the life journey. Most importantly, every moment of the gift of LIFE is to be lived as fully as possible. Nowhere along the line, even to the last breath, should anyone be refused the support necessary for this to happen.
