Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-09T06:20:13.621Z Has data issue: false hasContentIssue false
  • English
  • Français

The Role of Hospice Philosophy of Care in Nonhospice Settings

Published online by Cambridge University Press:  01 January 2021

Loring Conant  and
Arlene Lowney
Get access Rights & Permissions [Opens in a new window]

Extract

Many advances in public health and medical technology have contributed to the improved wellbeing and overall longevity of Americans. Such benefits, however, have been offset by a change in the nature and prolongation of the dying process. Daniel Callahan offers a challenge to caregivers in his observation of violent death by technological attenuation, and he sets an agenda to identify a more appropriate approach to the needs of the dying.

Over the past quarter century, hospice has increasingly been used as a resource for care at the end of life. However, according to 1995 estimates by the National Hospice Organization (NHO), hospice care presently accounts for only about 15 percent of the care of terminally ill patients in the United States. We will review issues of access and use of hospice services and examine the various institutional, professional, societal, and cultural barriers to hospice principles of care, and consider various options to promote optimal care at the end of life.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 24 , Issue 4 , Winter 1996 , pp. 365 - 368
Copyright
Copyright © American Society of Law, Medicine and Ethics 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Callahan, D., The Troubled Dream of Life: Living with Mortality (New York: Simon & Schuster, 1993): At 41.Google Scholar
National Hospice Organization, Fact Sheet: July 1996 Update, at 1 (1996) (citing 1995 estimate of 14.8 percent).Google Scholar
National Hospice Organization, Standards of a Hospice Program of Care (Arlington: National Hospice Organization, 1993).Google Scholar
World Health Organization, Cancer Pain Relief and Palliative Care (Geneva: World Health Organization, Technical Report Series, 1990).Google Scholar
See id.Google Scholar
Byock, I.R., “Feature Article,” Academy of Hospice and Palliative Medicine, 6 (1996): 2–3, 10–11.Google Scholar
Walsh, T.D., “Commentary on World Health Organization Policy Statement on Palliative Care,” American Pain Society Bulletin, July/Aug. (1993): 10–14.Google Scholar
Weissman, D.E. Griffie, J., “The Palliative Care Consultation Service of the Medical College of Wisconsin,” Journal of Pain and Symptom Management, 9 (1994): 474-79.CrossRefGoogle Scholar
National Hospice Organization, supra note 2, at 1.Google Scholar
Cassel, C.K. Vladeck, B.C., “ICD-9 Code for Palliative or Terminal Care,” N. Engl. J. Med., 335 (1996): 1232-34. The National Hospice Organization (NHO) also reported that the average length of stay for all hospice patients in 1992 was sixty-four days; in 1995, the length of stay declined to 50.4 days, due in part to late referrals. See National Hospice Organization, supra note 2, at 1.CrossRefGoogle Scholar
Christakis, N.A. Escarce, J.J., “Survival of Medicare Patients after Enrollment in Hospice Programs,” N. Engl. J. Med., 335 (1996): At 172–78.CrossRefGoogle Scholar
Id. at 175.Google Scholar
National Hospice Organization, supra note 2, at 1.Google Scholar
See, for example, “Disparities in Care for Patients Show Stark Racial Breakdowns,” Medical Ethics Advisor, 12 (1996): At 133–36.Google Scholar
National Hospice Organization, supra note at 1. Fifty-three percent of hospice patients in these data were male, with 68 percent aged sixty-five years or older; of the females, 72 percent were sixty-five or older. 1993 NHO statistics report that 78 percent of deaths were caused by cancer. The remaining 22 percent represented noncancer diseases: Cardiac at 10 percent, AIDS at 4 percent, renal at 1 percent, Alzheimer's disease at 1 percent, and other diagnoses at 6 percent. Cancer diagnoses had decreased from 84 percent in 1990 to 74 percent in 1995. Id.Google Scholar
SUPPORT Principal Investigators, “A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients,” JAMA, 274 (1995): 1591–98.CrossRefGoogle Scholar
Id. at 1594.Google Scholar
Lynn, J., “Caring at the End of Our Lives,” N. Engl. J. Med., 335 (1996): At 201–02.CrossRefGoogle Scholar
Solomon, M.Z.et al, “Decisions Near the End of Life: Professional Views on Life-Sustaining Treatment,” American Journal of Public Health, 83 (1993): 14–23.CrossRefGoogle Scholar
Von Roenn, J.H.et al, “Physician Attitudes and Practice in Cancer Pain Management: A Survey from the Eastern Cooperative Oncology Group,” Annals of Internal Medicine, 119 (1993): 121-26.CrossRefGoogle Scholar
Marks, R.M. Sachar, E.G., “Undertreatment of Medical Inpatients with Narcotic Analgesics,” Annals of Internal Medicine, 78 (1973): 173-81.CrossRefGoogle Scholar
Cleeland, C.S.et al, “Pain and Its Treatment in Outpatients with Metastatic Cancer,” N. Engl. J. Med., 330 (1994): 592-96.CrossRefGoogle Scholar
Chernyl, N.I. Coyle, N. Foley, K.M., “Suffering in the Advanced Cancer Patient: A Definition and Taxonomy,” Journal of Palliative Care, 10, no. 2 (1994): 57–70.CrossRefGoogle Scholar
See, for example, National Hospice Organization, “Knowledge and Attitudes Related to Hospice Care,” Gallup Organization (Sept. 1996).Google Scholar
Chernyl, Coyle, Foley, , supra note 23, at 64–67.Google Scholar
Walsh, D.et al, “Managing a Palliative Oncology Program: The Role of a Business Plan,” Journal of Pain and Symptom Management, 9 (1994): 109-15.CrossRefGoogle Scholar
Id.Google Scholar
See Weissman, Griffie, , supra note 8.Google Scholar
Dalton, J.A. Bernard, S., “Managing Cancer Pain: Content and Scope of an Educational Program for Nurses Who Work in Predominantly Rural Areas,” Journal of Pain and Symptom Management, 10 (1995): 214-23.CrossRefGoogle Scholar
Ferrell, B.R.et al, “The Pain Resource Nurse Training Program: A Unique Approach to Pain Management,” Journal of Pain and Symptom Management, 8 (1993): 549-56.CrossRefGoogle Scholar
Harnett, T., “Providers Persist in Search for ‘Good Death’,” Medical Ethics Advisor, 12 (1996): 1–3.Google Scholar
Callahan, , supra note 1, at 187–219.Google Scholar