The Hospice Philosophy

Death isn’t failure of healthcare, but a part of healthcare! Dame Cicely Saunders Founder of St. Christopher’s Hospice, 1967 What is the Difference Between Hospice and Palliative Care?

Hospice is an insurance benefit Palliative Care is a treatment philosophy

Palliative Care: Can be engaged in life threatening illness much Palliative earlier in acute care when Care curative treatment still on-going. Hospice Hospice-A 1982 Medicare benefit. For last 6-months of life. Usually home or residential based. Used when curative care no longer pursued NHPCO’s Hospice Philosophy Statement

Hospice provides support and care for persons in the last phases of an incurable disease so that they may live as fully and as comfortably as possible. Hospice recognizes that the dying process is a part of the normal process of living and focuses on enhancing the quality of remaining life. Hospice affirms life and neither hastens nor postpones death. Hospice exists in the hope and belief that through appropriate care, and the promotion of a caring community sensitive to their needs that individuals and their families may be free to attain a degree of satisfaction in preparation for death. Hospice recognizes that human growth and development can be a lifelong process. Hospice seeks to preserve and promote the inherent potential for growth within individuals and families during the last phase of life. Hospice offers palliative care for all individuals and their families without regard to age, gender, nationality, race, creed, sexual orientation, disability, diagnosis, availability of a primary caregiver, or ability to pay. Hospice…

• Focuses on quality of life for patient and family.

• Focuses on celebration of life when time is precious.

• Hospice patient’s suffer less, pain, depression and other maladies

• Hospice patient’s cost less to care for than dying patient’s not in hospice

• In general-hospice patient’s live longer in hospice than matched controls not in hospice

• Is provided by a team that provides for physical, emotional, social and spiritual care during the last stages of illness, dying and bereavement period. What is our job in medicine?

• It’s NOT to ensure health and survival • We have remarkable power to push against the limits of genes, cells, flesh, and bone • This power is, and will always be, finite • It IS to enable well-being – the reasons one wishes to be alive

• It’s not death that the very old fear, it’s what happens short of death.

Dr. Atul Gawande – “Being Mortal: Medicine and What Matters in the End.” p259, p 285 Hippocrates Said:

• "To impose treatment on the patient overmastered by disease is to display an ignorance akin to madness.”

Curative Vs. Palliative

 Primary Goal = cure  Primary Goal = relieving suffering  Object of Treatment = the disease  Object of Treatment = patient and family  Symptoms treated primarily as clues to diagnosis  Distressing symptoms treated as entities themselves  Primary value placed on measurable data such as labs and tests  Subjective and measurable data valued  This model tends to devalue data that is  This model values patient experience as an illness subjective, immeasurable or unverifiable  Therapy indicated if it controls symptoms for  Therapy indicated if it eradicates disease or slows relieves suffering progression  Patient is viewed as complex being with physical  Patient’s body differentiated from mind emotional social and spiritual dimensions  Patient viewed as collection of parts so there is  Treatment congruent with values, beliefs and little need to get to know the whole person concerns of patient & family  Death is the ultimate failure  Enabling a patient to live fully and comfortably until he or she dies is a success Principal Goals of Hospice are Minimize Suffering and promote Healing

Suffering Healing is not curing  Pain  Healing is about  Delirium wholeness  Dyspnea  Reconciliation; repairing relationships  Nausea/vomiting  Finding meaning and  Constipation purpose in reviewing one’s  Anxiety/depression life near the end  Spiritual Angst  About finding completion

“The Talk” - “Dr. Informative”

• A common pit-fall of having extensive medical knowledge.

• It’s the meaning behind the information that people are looking for more than facts.

• The best way to convey meaning is to tell people what the information means to you. • “I am worried.”

Dr. Atul Gawande – “Being Mortal: Medicine and What Matters in the End.” p206 “The Talk” - 3 Important Questions

1. What are your biggest fears and concerns?

2. What goals are most important to you?

3. What trade-offs are you willing to make, and what ones are you not?

Dr. Atul Gawande – “Being Mortal: Medicine and What Matters in the End.” p234 Discussion Questions

• What do you think “medicalized” mortality means? • How can we shift to a more humane, compassionate approach to mortality?

• When is the appropriate time to introduce hospice in the treatment of those with life-threatening illnesses