End-of-life care is the treatment of someone with a short amount of time left in their life or somebody with a terminal or incurable illness. When some patients reach the point of making this decision, they want to enjoy the rest of their life without a machine assisting them or worrying about any type of treatment. The big debate with end-of-life care is whether or not the patient should have the right to refuse care when the patient reaches the point of making this decision. (NIH 1)
When patients have a disease that is slowly killing them, such as Alzheimer’s, the doctors can usually just medicate the patient for the side effects or to slow the disease. A lot of patients that have terminal illnesses just want to enjoy the time that they have left around their loved ones and not be treated for a disease that the patient has almost no chance of surviving. When a patient is expected to have 6 months or less to live, the patient can be admitted into hospice care by an attending physician, and the hospice medical director. (Shiel 1)
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A hospice home is where patients that are in the final phase of their terminal illness go to focus on their comfort and quality of life, instead of cure. There are four types of hospice care. The first type is routine home care, which is most common and typically includes nurses, social workers, and volunteers. Routine home care is delivered in the patient's home, whether that be their house or an assisted living facility in which the patient is residing. The second type is continuous home care, which is more intense than routine home care. The patient receives round-the-clock care to manage the patient’s symptoms, usually from hospice caregivers. The third type is general inpatient care, which is usually for treating symptoms that can’t be cared for properly through home care. General inpatient hospice care is usually short-term and can be provided in the hospice unit of a hospital, a long-term care residence, or a free-standing hospice facility. The fourth and last type is respite care, which is short-term inpatient care that is meant to benefit the family caregivers as well as the patients. Respite care usually has a limit and can only be received on occasion. Respite care is for qualifying hospice patients, per Medicare guidelines. Not all inpatient hospice services offer respite care. (Concordia 1) (Hospice Quality Care Inc. 1)
The goal of hospice care is to allow patients to be comfortable and free of pain so that they can live each day to its fullest. Some pros of hospice care include personalized care and support, lessening of financial burdens, 24-hour everyday care, and respect for patient’s wishes instead of having to worry about hospital procedures. The hospice home also must supply medications to relieve the symptoms related to the patient’s terminal illness. (Geisman 1)
The patient also has the right to refuse hospice care. Some cons to hospice care include the denial of diagnostic tests because the cost of the test is the financial responsibility of the hospice home, also once the patient is in hospice care, hospitalization is discouraged, and finally, participation in experimental treatments or clinical trials is not allowed. Hospice homes don’t want the patient to participate in anything that prolongs their life because the patient decided to end treatments and enjoy the rest of their life; all further costs are the hospice home’s responsibility. (Morrow 1)
Another thing that patients who are terminally ill choose to do is physician-assisted suicide. Physician-assisted suicide is when a physician facilitates a patient's death by providing the necessary means and information to allow the patient to perform the life-ending act. Physician-assisted suicide is legal in only nine US states, two of those states being via court decisions. (AMA 1)
Some people believe that physician-assisted suicide should be legal everywhere. Some pros to physician-assisted suicide include the patient having to meet legal requirements to perform this act, doctors taking a minimal role in the process, allowing the patient to have control over their final decisions, and the end usually being the same no matter how the outcome is reached. Some doctors will allow patients to perform physician-assisted suicide and other doctors will not. (AMA 1)
A lot of people believe that physician-assisted suicide shouldn’t be legal at all. Some cons of physician-assisted suicide include the medication given for physician-assisted suicide sometimes does not work, some patients take advantage of the option and do it for reasons other than their health, and most people do not go through with the process. In Oregon, where physician-assisted suicide is legal, about 1 in 6 people who are given a terminal illness say that they talk with their families about the possibility of taking their life through this process. The number of patients who speak with a doctor about going through with this practice is about 1 in 50. (Chief 1)
Considering all of the information I’ve read about both debates having to do with end-of-life care, my stances on both are very different from one another. I do believe that the right to refuse or to receive hospice care should be the patient’s choice. In 2014, about 1.3 million patients received hospice care. Of all patients, 11% were live discharges, and 13% survived the 6-month period. On average, the length of time patients receive hospice care is 70 days. I believe that these statistics show that hospice patients made the right choice with their disease. (Omni Care 1)
Contrary to my stance on hospice care, I believe that physician-assisted suicide should not be legal anywhere. In the US, from 1998-2017, 4249 patients were written for PAS drugs, but only 66.3% of the patients used the drugs to end their lives. The majority of patients were 69-89 years old and 63.1% had cancer. I believe that if the patient has a terminal illness and they want to stop fighting it, then the patient should just be admitted to hospice care. While in hospice care, the patient can enjoy the rest of the time they have left and are provided with medication to make sure they are not in pain. I don’t believe that it is practical for a doctor to assist a patient with taking their own life especially because the doctor’s job is to keep the patient alive and well. (ProCon 1)
Reference Page
- Association, American Medical. “Physician-Assisted Suicide.” American Medical Association, AMA, https://www.ama-assn.org/delivering-care/ethics/physician-assisted-suicide#:~:targetText=Physician-assisted suicide occurs when the patient may commit suicide).
- Care.com. “7 Benefits Of Hospice Care.” Care.com, Care.com, 20 Mar. 2018, https://www.care.com/c/stories/5517/benefits-of-hospice-care/.
- Chief, Editor in. “19 Main Pros and Cons of Legalizing Physician-Assisted Suicide.” ConnectUS, ConnectUS, 15 Apr. 2019, https://connectusfund.org/8-main-pros-and-cons-of-legalizing-physician-assisted-suicide.
- Jr., William C. Shiel. “Definition of Hospice Care.” MedicineNet, MedicineNet, 11 Dec. 2018, https://www.medicinenet.com/script/main/art.asp?articlekey=24267.
- Marr, Diann. “Hospice Quality Care, Inc.” What Is Hospice Care, Judy Harrison, http://www.hospicequalitycare.com/Pages/HospiceCare.aspx.
- Ministries, Concordia L. “4 Types of Hospice Care.” Nonprofit Senior Health Care, Concordia Lutheran Ministries, https://www.concordialm.org/blog/4-types-of-hospice-care.
- Morrow, Angela. “Pros and Cons to Consider When Deciding Hospice Care for a Loved One.” Verywell Health, Verywell Health, 6 May 2019, https://www.verywellhealth.com/pros-and-cons-of-hospice-care-1132299.
- “NCI Dictionary of Cancer Terms.” National Cancer Institute, NCI, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/end-of-life-care#:~:targetText=End-of-life care includes supportive care and hospice care.
- Silva, Dennis. “Discharge from Hospice: When a Hospice Patient Survives.” Omni Care Hospice, OCH, 14 Feb. 2018, https://omnicarehospice.com/discharge-hospice-patient-survives/.
- “State-by-State Physician-Assisted Suicide Statistics.” ProCon, ProCon, https://euthanasia.procon.org/view.resource.php?resourceID=006992.
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