Euthanasia is a very touchy subject, especially within the medical field. As a healthcare advocate, it is our job as professionals to better the lives of our patients. What happens when there is nothing more you can do?
I understand, being a Home Health Aide that works a lot with Hospice, that comfort care is important. But truly, when a suffering patient looks to you to ease the pain what do you do? Should you apologize and say their is nothing more I can do?
I can hardly say no more treats to my cat when he gives puppy dog eyes, much less a patient dying alone of cancer. In my opinion, for what it is worth, Euthanasia is most certainly not murder and should never be referred to as such.
If Euthanasia was legal, but very strict in regulations and rules, it would be very beneficial to many terminally ill patients. This may be the only healthcare decision a patient makes within their life, and they should be allowed to make such a decision when conditions permit. We all have choices in this world, what gives you or I the right to take such choices away from someone in such a situation.
What is your opinion? Do you agree or disagree? Do you have a story, personal or not that pertains to this topic?
The Washington Post is an internationally respected news organization that doesn't let reporters just print something without vetting it and being sure that there is something there more than just "spin" or misinformation. There are physicians working in the hospice industry who have seen these things and spoken about them. They are occurring.
Nobody is saying that you are doing these things, so no need to mock. If you really care about the patients, then you might consider that: if these things are happening, it's really a terrible thing! And yes, the Euthanasia Society of America's successor is the National Hospice & Palliative Care Organization, so take some time to absorb that and ask yourself what effect that would have on the original mission Dame Dr. Cicely Saunders brought to the world. Would it change it at all? No doubt!
Of course, if you support euthanasia in any form, you won't find that objectionable but many do, especially the patients who are not interested in being subjected to it.
There are obviously many dedicated EOL care professionals, but not all are dedicated to Dr. Saunders' mission. Some have changed it to something else.
Specializes in NICU, PICU, Transport, L&D, Hospice.
RonPanzer
I noticed in your co-authored article that you do not (apparently) consider Alzheimers to be a terminal diagnosis and that Alzheimers hospice patients die from dehydration. This statement is then linked to Hospice Patients Alliance and the Terry Schiavo life and hope network.
Do you honestly believe that Alzheimers victims do not have a terminal condition and do you believe that they ought not have access to hospice support in the last 6 months of their lives? What do you believe is the cause of death for dementia patients, in general? Sepsis, dehydration, starvation? If a severely demented patient at end of life stops eating and drinking, should the family and caregivers start an IV to make certain that they do not become dehydrated to the point of death?
I never stated what you imply. Obviously, Alzheimer's patients have complications that lead to death at the end-stage and everybody knows that, and no, it would be ridiculous to do IV fluids when a patient is truly dying. And no, I don't think they should be denied access to hospice if they are nearing the end-stages of Alzheimer's disease.
Good hospice care, as we've said many times, is a wonderful service, but if it is misused, patients can be hastened to death through a variety of means when clinically inappropriate actions are taken, like yanking away medications from stable chronically-ill patients when those patients are still receiving benefit from those medications and are not declining.
Nobody ever said Alzheimer's was not a terminal illness! Please read what was written.
You should be aware that there is quite a significant effort being exerted to push dementia patients into hospice before they are any where near "terminal" or even a year or two out from dying of the end-stage complications of the these diseases. Eugenics and euthanasia advocates are influencing healthcare decision-making. Some believe these patients should be put to death rather than caring for them with basic care when they can benefit from eating and drinking and are ​absolutely not catabolic!
Specializes in NICU, PICU, Transport, L&D, Hospice.
I never stated what you imply. Obviously, Alzheimer's patients have complications that lead to death at the end-stage and everybody knows that, and no, it would be ridiculous to do IV fluids when a patient is truly dying. And no, I don't think they should be denied access to hospice if they are nearing the end-stages of Alzheimer's disease.
Good hospice care, as we've said many times, is a wonderful service, but if it is misused, patients can be hastened to death through a variety of means when clinically inappropriate actions are taken, like yanking away medications from stable chronically-ill patients when those patients are still receiving benefit from those medications and are not declining.
Nobody ever said Alzheimer's was not a terminal illness! Please read what was written.
You should be aware that there is quite a significant effort being exerted to push dementia patients into hospice before they are any where near "terminal" or even a year or two out from dying of the end-stage complications of the these diseases. Eugenics and euthanasia advocates are influencing healthcare decision-making. Some believe these patients should be put to death rather than caring for them with basic care when they can benefit from eating and drinking and are ​absolutely not catabolic!
Yes, there is a movement to change the level of care that folks with chronic and debilitating dx like the Dementia spectrum be allowed to access palliative care and support much sooner than they now can. As you are likely aware, these devastating diseases are brutal and they drain the energy and resources of families as they seek to provide for their loved ones. When these dementia patients don't die after 6 months of hospice care the families are often deeply saddened by the loss of the support and services, not to mention the supplies and medication support when they are discharged.
It is really unfortunate that so many people are so afraid of and poorly informed about how hospices actually care for their patients. As you continue to make generalized statements about "some believe these patients should be put to death rather than caring for them with basic care when they can benefit from eating and drinking and are ​absolutely not catabolic!" you insult hospice nursing professionals. There is no evidence of an abundance of this attitude within hospice. There is an abundance of evidence that hospices seek to empower patients and their families, seek to meet the palliative needs and desires of their patients, and seek to advocate for a dignified death which conforms to the expectations of the patient rather than the medical or acute care community.
You seem to be very concerned about euthanasia, yet you are focused wrongly on hospice. If you want to affect euthanasia you should address that rather than smearing the image of hospice and the professionals who work diligently on behalf of their dying patients.
Sure, unethical health professionals might seek to hasten the lives of their patients...
Why you are suggesting that this might happen more in hospice than say ICU, or the SNF, or Home Care is really beyond me. The trend in hospice is to keep as many patients on service for as long as possible, not bring them on and kill them off quickly. That is a very expensive and not very profitable way to conduct business.
Actually, we have received reports of actual hastened deaths of Alzheimer's patients in hospice, from hospice staff, complaining about the policy of management that took Alzheimer's patients out of Alz units, sent them to hospice and in two weeks they were all dead.
This is not attacking all hospice, and we never said that. But it is real. Please do not mischaracterize what I wrote.
I never said it doesn't happen in other settings. It does! but we have real healthcare professionals who are concerned about these happenings. Hospice is not a homogeneous industry and there are some who do not practice as you obviously do!
We are very aware of how hospices work. See my book, Hospice Patients Alliance Family Guide to Hospice which delineates the standards of care in total from the CFR, the levels of care and how hospice works in detail, used by some hospices to train their personnel actually.
You criticize me for "being concerned about euthanasia" but this very discussion here at Allnurses is about euthanasia. It's not the only thing we are focused on, but we are trying to remain relevant to the forum's thread here and the discussion going on.
If you think there is no evidence of this attitude toward dementia patients, you need to read some of the end-of-life journals, articles, books and the statements of stakeholders regarding dementia patients, the costs involved in caring for them and the utilization of health care resources.
There is an endless supply of patients for hospices in some areas, so ending the lives of patients does not eat into their revenue stream. Of course, in those hospices where they do not have a full census appropriate for their staffing abilities, then they would be unlikely to kill off patients. Nursing homes have been known to "empty beds" so new residents can be brought in. Hospice facilities sometimes do the same thing, according to hospice professionals who have reported to us.
Hospice is not exempt from the human condition, and there are all types working in the industry, some with great integrity and some not. And some administrators view the hospice as a business through which they can enrich themselves, getting paid $400,000 per year and more in some cases, even nonprofits!
The world is filled with many types of people. Not all are dedicated to the mission of serving the patients in the way that you obviously are, and I would respect those who do care!
I don't know about blatant premature killing of patients but let's not be naive either.
Every apsect of healthcare has their dark side. I've worked for a long standing reputable legit home health agency that has been under the eye of just about everyone in our small community. Yet read the home health forum for their sketchy stories. Hospitals and LTC's have theirs as well. Hospice doesn't have the market cornered on integrity anymore than they are without deficiencies and possible corruption. Hospices are individually owned just like home health. We're required to have professional advisory boards as well and yet there is still fraudulent practices. And non profit doesn't guarantee anything.
There is an endless supply of patients for hospices in some areas, so ending the lives of patients does not eat into their revenue stream.
I don't know where you're getting your information. I work for one of the largest hospices in the country, and censuses have been down nationwide for a year and a half to two years. Substantially.
Exactly! Hospice is the least regulated of all the healthcare niches, for sure. I know of hospices that once inspected at their initial certification/approval as a State-approved provider, never was inspected again at all for 8 years!
Home health agencies are much more stringently inspected and required to comply with the standards of care, same thing with nursing homes that are regular inspected much more frequently than hospices. Hospitals, much higher standard for compliance than hospices and held to those standards of care!
Those good hospices that voluntarily adhere to the standards are wonderful examples of what can be done to serve the patients, but when hospice agencies are run by cutthroat administrators, perhaps corporate leaders doing fraud as you mention, the patients can suffer, be run through the agency simply to generate a revenue stream, with little consideration of the patients' well being, which is truly tragic.
I have the greatest admiration for those nurses who do care and do adhere to the standards, providing the very best for the patients!
you can't generalize from your agency to all other agencies. The trend is for more and more patients to be enrolled in hospice as this is the most cost-effective utilization of Medicare/Medicaid resources. That is the policy being implemented. Utilization will increase over time, but of course, there are fluctuations from time to time, but the general trend is absolutely increased utilization. Nobody who is in policy circles doubts this, and census will increase.
The problem in some geographic areas is that you have limitless numbers of hospice businesses entering the same market, competing for the same market share of patients, so the census goes down per agency, and some agencies go out of business or are bought up, absorbed by other larger non-profit or for-profit hospice corporations. Some cities have 50 hospice agencies serving the same metro area! which is ridiculous and they all fight to get referral from the physicians, social worker discharge staff, nsg homes, etc.
As a generational trend, the baby boomers have already started entering hospice and are increasingly doing so. Overall census nationwide will increase, but individual hospice agencies will see varying censuses due to local competitive conditions
Specializes in NICU, PICU, Transport, L&D, Hospice.
I do not currently work in a hospice saturated market.
I feel the same way about hospice "alarmists" as I do about anti-vaxers.
Given that this thread is about euthanasia, and hospice is NOT in the business of euthanasia as a philosophy or business model, I will cease and desist.
ronpanzer, what are your credentials? You created the Hospice Patients Alliance, and you self-published a "book" on the website. You say you have friends in the hospice industry, and they agree you about the issues. (Not really good evidence there.) An excerpt from your "book":
Probably most physicians today want their decisions to reflect the latest medical science and the evidence. It makes sense. But anyone who knows anything about medical studies knows that different studies result in different outcomes and conclusions. The design of the studies, the number of subjects, the controls used, and so many other factors effect what conclusions are reached. Sometimes, if you want a certain result, you can be sure to get it if you design the study just so. In fact, there are well-respected physicians debating the whole idea of "evidence-based medicine. A November 2008 seminar was entitled, "The Evidence Never Lies? Critical Debates in Evidence-Based Medicine" with leading physicians, bioethicists and professors of philosophy debating the pros and cons of this whole field of endeavor. Topics included: "What's right and what's wrong with evidence-based medicine?" "What is the role of clinical research evidence in medical practice?" and "What is the patient's role in medical decision-making?"
If evidence-based medicine is used to ration care and decide what treatments are offered citizens under Medicare, Medicaid or a possible national health system, who decides what evidence and what studies are used? Who decides what the conclusions should be? Will the physician and patient decide or will a bureaucrat somewhere in the government, a PPO, HMO or other managed care company decide?
You googled a seminar agenda on bioethics in Canada, and you use that as a basis that evidence-based medicine is somehow...not evidenced-based? Did you attend the seminar? Do you even understand how standards of care are developed and the levels of evidence to determine the standards of care?
You might be a master googler, but an expert in hospice you are not.
ronpanzer
19 Posts
The Washington Post is an internationally respected news organization that doesn't let reporters just print something without vetting it and being sure that there is something there more than just "spin" or misinformation. There are physicians working in the hospice industry who have seen these things and spoken about them. They are occurring.
Nobody is saying that you are doing these things, so no need to mock. If you really care about the patients, then you might consider that: if these things are happening, it's really a terrible thing! And yes, the Euthanasia Society of America's successor is the National Hospice & Palliative Care Organization, so take some time to absorb that and ask yourself what effect that would have on the original mission Dame Dr. Cicely Saunders brought to the world. Would it change it at all? No doubt!
Of course, if you support euthanasia in any form, you won't find that objectionable but many do, especially the patients who are not interested in being subjected to it.
There are obviously many dedicated EOL care professionals, but not all are dedicated to Dr. Saunders' mission. Some have changed it to something else.