Hospice: Advantages and Disadvantages
There are advantages, and disadvantages, for Medicare patients to shift to hospice toward the end of life. The public hears about all the virtues of hospice since hospice has become a reported $14 billion-dollar-a-year business. It is a business in for-profit groups, and the shady things that go on in businesses go on in hospice groups. The public doesn’t know the many details that involve the hospice program, and how choosing hospice can be the worst possible choice for a person. This page provides some answers and research sources.
Basics of hospice:
Two physicians must prepare a statement that the person has a medical condition in which death can normally be expected within six months.
Certain pain-relieving treatment in the hospital is no longer available. This includes treatment to remove the cause of intense pain.
Hospitalizations are discouraged and the criteria for admission to the hospital, and the coverage is poorly defined. Hospitalization is discouraged. Emergency hospital admission is in most cases not available, and the patient suffers needlessly when the patient intended to die peacefully. Unknown to most people, they can opt out of hospice at any time.
Certain blood or other tests needed to discover the source of pain is not available. So suffering that can be easily corrected continues, with the only remedy being more pain medication.
By being at home rather then in a traditional hospital setting, the patient may not have access to the array of medical machinery that would be available in a hospital. That could result in great pain that could otherwise have been prevented by hospital facilities.
Hospice organizations are provided a specific amount of money, and their increased profits come from withholding care for the hospice patient.
Home hospice care is often extremely hard on the family caring for the in-home hospice patient.
The type and competency of people sent by hospice groups to the home cannot be controlled by the hospice patient. [Medicare home care, on the other hand, provides more control over the type of help acceptable to the patient.]
Choosing hospice generally means abandoning medical treatments and hospitalization for other medical problems that may arise, thereby inflicting even more pain on the hospice patient who is limited to pain medicationn—and even that may be withheld.
Hospice does not provide 24-hour home care as a hospital would provide. Hospice personnel are available on call 24 hours a day. They teach family members to become caregivers and do the many tasks that trained medical personnel would do.
Sampling of Shortcomings of Hospice
A hospice patient gets a heart attack and is suffering greatly. That person has given up the right to obtain hospitalization. The hospice patient has excruciating paint due to cancer spreading, to the bones, where the primary and sometimes only method of pain relief is radiation.
A message from a nurse in Texas stated: “He had cancer but seemed to be feeling fine. After hospice got hold of him, he was in a vegetative state and died a couple of days later. My daughter, Stephanie, who is a nurse was very upset. She said that hospice killed him by giving him such large doses of morphine. The drugs they gave him had a very negative effect on him. They continued giving him the morphine which eventually killed him.”
Hospice providers have been accused of boosting their revenues with patients who aren’t near death and not eligible for hospice― people healthy enough to live a long time with traditional medical care. In hospices, patients give up their rights to “curative” measures because they are presumed to be futile.
According to former and current employees interviewed by Bloomberg News. To increase revenues, hospices tie employee bonuses to enrollment, pay kickbacks to patients and referral sources, and use false diagnoses to admit ineligible patients, according to whistleblower, or qui tam, suits against three chains filed under the False Claims Act, which allows plaintiffs to share in any financial recovery for the government.
Wall’s lawsuit, filed in federal court in Dallas, accuses VistaCare of paying illegal kickbacks to patients and nursing-home employees who referred residents to hospice. It also accuses VistaCare of doctor shopping to get patients certified.
Media Articles on Hospice Problems and Horror Stories
An article appearing at http://www.hospicepatients.org/questionable-death.html described the deliberate over dosage (i.e., murder) of patients by physicians and other medical personnel.
Hospice Patients Alliance
Questionable Death, Assisted Suicide,
Mercy Killing (& Involuntary Euthanasia)
by Ron Panzer, January 2000
Overmedicating the Terminally Ill:
A Method of So-Called "Mercy Killing" or Euthanasia
One method of hastening death used by physicians, nurses and even family members is to administer overly high dosages of narcotics, sedatives or antidepressants when the patient has no need for them. Giving high dosages of narcotics when the patient is not in pain or does not have a symptom requiring the use of that narcotic is inappropriate and may cause death. [The crime of murder.] The most serious adverse effect of giving inappropriately high doses of narcotics, sedatives and antidepressants is "respiratory depression." Respiratory depression can be so severe that breathing stops altogether resulting in death. Families need to ask questions and know exactly why medications are given and to be especially aware of rationales for increasing a dose.
Morphine is commonly given for severe pain in terminal illnesses, especially in cancer pain. In the case of severe pain, extremely high doses of morphine or other narcotics may be necessary to control that pain and have been determined to be safe to administer under the careful supervision of the physician and hospice staff.
Morphine is also given for other reasons which most family members may not understand. For example, in the case of end-stage heart failure with respiratory congestion resulting from the weakened heart action, fluid from the blood percolates out through the capillaries in the lung, causing severe respiratory congestion and distress. Medical textbooks list morphine given in combination with a diuretic like Lasix (furosemide) as a classic and one of the most effective ways of reducing respiratory distress and congestion caused by such heart failure.
In the case of overly high dosages of narcotics, sedatives and antidepressants, family members may be the only protection left for a medically comatose patient. "Medically comatose" refers to a patient that would not normally be comatose at that time due to his illness, but who has been placed into a coma (nonresponsive and unarouseable mode) by medications being given. The patient can no longer speak for himself, and the family is the only advocate left for that patient. If the patient was willing to sleep during the very last days of his life, then administering high doses of sedatives might be acceptable if the situation warranted it. However, there are physicians and nurses who believe in administering high doses even when the patient is not willing and receptive to those doses. [Emphasis added.]
Research Demonstrates Some Physicians
Approve of Actively Causing Death (Active Euthanasia)
Research studies published in medical journals confirm that a small percentage of health care professionals, including physicians, admit to having hastened a patient's death. It is reasonable to conclude that a larger number have hastened death and that some physicians are not willing to admit what they routinely do in secret. The ethics of physician assisted suicide is currently being actively debated throughout our nation.
A 1998 article in the Journal of the American Medical Association conclusively reports that physician assisted suicide or hastening death is occurring and is not "unheard of" or a "rare" occasion. This report documents cases where the patient wished to die and was assisted by his or her physician to do so. A summary of this article is listed at: The practice of euthanasia and physician-assisted suicide in the United States. [For complete article see JAMA 1998 and search from the JAMA site for the following article: Aug 12;280(6):507-13 entitled "The practice of euthanasia and physician-assisted suicide in the United States: adherence to proposed safeguards and effects on physicians." written by Emanuel EJ, Daniels ER, Fairclough DL, Clarridge BR done at the Center for Outcomes and Policy Research, Division of Cancer Epidemiology and Control, Dana-Farber Cancer Institute, Boston, Mass 02115, USA.]
In the above survey of 355 oncologists, "(15.8%) reported participating in euthanasia or physician assisted suicide." "Thirty-eight of 53 oncologists described clearly defined cases of euthanasia or physician assisted suicide." In the cases reported by that 15.8% of oncologists, "(60.5%) [of the patients] both initiated and repeated their request for euthanasia or physician assisted suicide, but 6 patients (15.8%) did not participate in the decision for euthanasia or physician assisted suicide. [emphasis added] Thirty-seven patients (97.4%) were experiencing unremitting pain or such poor physical functioning they could not perform self-care."
What does it mean that "6 patients did not participate in the decision for euthanasia or physician assisted suicide?" Isn't the obvious conclusion: these patients died without having requested to be killed, without asking for their death to be hastened. Who is deciding who dies and who lives in these situations? Do doctors have the right to play God with the terminally ill, even when the patients have NOT requested such "assistance?"
In the case of a patient who definitely does not wish to die and who is actively "euthanized" against his wishes, that is an even more serious question of medical ethics and law. If you are aware of a situation where the physician, nurse or other family member is giving dosages of medication which have been directly refused by your loved one, you need to directly confront that physician, nurse or family member and ask them to explain their actions. If you are not satisfied with that explanation, you need to promptly get in touch with an attorney for professional advice.
Significant Number of Physicians May Approve of Euthanasia and/or Physician Assisted Suicide
It is common knowledge in hospice that there are some physicians in the community who do not prescribe adequate pain medications to properly control the pain of patients with severe pain. It is also common knowledge in the industry that there are some physicians who are extremely "aggressive" in treating pain with narcotics. Being "aggressive" in treating pain is admirable and exactly on target when it comes to hospice care and its reason for being. However, it is also common knowledge that some physicians step over the line and are willing to "push" a patient into death by hastening its arrival through the use of high doses of sedatives and narcotics. Hospices will not normally inform you or your loved one if your physician falls into either extreme category: those who under-medicate for pain or those who overmedicate and hasten death.
An article in the Archives of Internal Medicine, Vol. 160 No. 1, January 10, 2000, "Attitudes and Practices Concerning the End of Life - A Comparison Between Physicians From the United States and From the Netherlands" (by Dick L. Willems, MD, PhD; Elisabeth R. Daniels; Gerrit van der Wal, PhD; Paul J. van der Maas, PhD; Ezekiel J. Emanuel, PhD) reports the varying percentages of physicians in Oregon who were willing to increase the dosage of morphine given under various patient circumstances. This article is summarized briefly at: Entrey-PUBMED where you can search for the article by title, you can also order a full copy of the article. The article is also available from the AMA site at: Archives of Internal Medicine - AMA.
1. When pain was involved, 97% stated they approved of increasing the dosage of morphine; 53% approved of physician assisted suicide ("PAS") 24% approved of euthanasia
2. When severe weakness and debility of the patient were involved, 36% approved of increasing the dosage of morphine; 37% approved of "PAS"; and 14% approved of euthanasia.
3. When patients felt that they were a burden on their families, 24% of the physicians approved of increasing the morphine dosage; 24% approved "PAS"; 7% approved of euthanasia.
4. When patients felt that their lives were meaningless, 20% of the physicians approved of increasing the morphine dosage, 22% approved of "PAS", and 7% approved of euthanasia.
See the table of data at: http://archinte.ama-assn.org/issues/v160n1/fig_tab/ioi81180_t3.html.
Increasing the dosage of morphine when pain is involved makes sense and leads to improved quality of life for the terminally ill. However, other than hastening a patient's death, what is the reasoning for increasing the dosage of morphine when patients feel their life is meaningless or feel that they are a burden on others in the family? It is obvious that physicians approve of hastening death in many end of life circumstances. 20% or one out of five physicians approved of "PAS" when patients felt their lives were meaningless. 24% approved of PAS when the patient felt they were a burden.
Even more surprising is that 24% of the physicians approved of euthanasia when the patient had severe pain, 14% (or one out of every 7 physicians) approved of PAS when the patient had debility, 7% when the patient felt they were a burden or felt that their lives were meaningless. 7% is one out of 14 physicians who admitted to being willing to act to end a patient's life in those circumstances.
48% of the physicians reported that patients had requested "PAS" or euthanasia. None of the physicians admitted to having performed euthanasia, but 7% admitted to performing "PAS", and 2% admitted to ending a patient's life without a request from the patient.
While these results are from confidential surveys of physicians in Oregon, attitudes of physicians around the country may be quite similar.
Criminal Prosecutions on Record for Hastening Death
For a discussion of the criminal prosecutions of some cases involving the deaths of patients in health care situations, please refer to the following article posted at the American Society of Law, Medicine and Ethics website: "Criminal Act or Palliative Care? Prosecutions Involving the Care of the Dying" by Ann Alpers, JD. Ann Alpers is a professor at the University of California at San Francisco's School of Medicine and has taught Medical Bioethics, among other topics.
What To Do About Involuntary Euthanasia
If you know of any incidences of involuntary euthanasia where a patient was medically killed (various methods), please contact us to let us know. Visit our euthanasia and hospice information center where we provide directions on how to stop these medical killings. Involuntary euthanasias, if continued, offer the greatest threat to hospice as we know it. In countries where euthanasia is encouraged, hospice services decline and patients are killed rather than cared for (documented in The Netherlands, Europe).
One important point to remember though, you will need to send a detailed complaint to the State Board of Medicine as soon as possible, because in some cases, the DEA will wait to see the findings of the State Board of Medicine. You can also file a complaint to theState Board of Nursing if a nurse was involved in administering a fatal dose of narcotic. It is wise to consult a medical malpractice attorney before filing your complaint to the Board of Medicine and it is also important to get a medical review by an independent physician.
If you wish to stop the involuntary euthanasias (medical killings of patients), you will need to get a copy of the medical record for an independent medical review of your loved one's case. Your attorney can assist you in that, because most hospices will fight tooth and nail to never give you the medical records if something truly terrible happened. If you don't have or know of a medical malpractice attorney in your area, you can search for a plaintiffs' attorney.
It is very important that you try to find an attorney who files claims as a plaintiffs' attorney to represent you. If you get an attorney who handles medical malpractice, but regularly represents the corporations, you may not get the legal representative you deserve! Hospices have been known to falsify documentation, delete information, send incomplete records, stall and many other tactics that infuriate the families of the victims. A plaintiff's attorney will be able to successfully overcome the obstacles that hospice corporations routinely throw in the way of families seeking the truth (and a full, accurate copy of the medical record).
Taking the step by step approach to achieving justice will help make it more likely that the truly egregious violations of standards of care are noted (some you may miss, not being a physician) and corrected through the government justice departments and local district attorney's office. Having a medical malpractice attorney help you will assure that the complaint to the Board of Medicine and Board of Nursing is written in such a way that the allegations are not capable of being misunderstood or brushed aside.
If people remain silent about these medical killings, nothing will happen. Rape, murder and child molestation can only flourish if families or victims remain silent. Only when crimes are reported can they be stopped. In the same way, hospice abuses must be reported for the medical killings (involuntary euthanasias) to stop. We urge you to report what you know to our government representatives. See our hospice and euthanasia information and action center for addresses to write to, sample letter and examples of involuntary euthanasias in our nation. You can make a difference! Let others know about our efforts to stop medical killings!
Alternate to Hospice: Medicare and Hospitalization
Hospital treatment for breathing difficulties, that hospice does not allow.
Hospital treatment for pain from bone cancer, that hospice does not allow.
Patient selection of home care and medical and assisted living personnel.
Testimony to members of Congress.
Hospice patient neglect in media articles.
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