Palliative care is medical treatment provided by a specially trained team of doctors, nurses, social workers and other specialists who work together with a patient’s doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.
Hospice care operates on the belief that each of us has the right to die pain-free and with dignity, and that our families should receive the necessary support to allow us to do so. It is considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury. Hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. Support is provided to the patient’s loved ones as well.
Hospice can be initiated after a doctor has certified a person is likely to die within the next 6 months. The patient may improve and be discharged until a later date, or not die and have hospice care extended until they do.
According to the 2015 report Facts and Figures from the National Hospice and Palliative Care Organization, 35.5% of patients were admitted to hospice seven or fewer days before death; 14.8% entered 8 to 14 days before death; 12.9% entered 14 to 29 days before death. Fully 63.2% of those who die – and their families – receive the benefits of comfort care and 24/7 guidance and support for less than one month. That’s hardly enough time to develop a relationship with the team, wrap your head around the reality of death, and take care of the personal business that is then left to loved ones.
In sum, we need to change our thinking about hospice and stop using it as a last resort when it’s a last reward.
VOLUNTARILY STOPPING EATING AND DRINKING (VSED)
The natural dying process involves the cessation of taking nutrition and hydration. This is one of the most difficult times for caregivers because it is equally natural to want to feed someone we care for. Pushing food and or liquids on a person who is dying can cause them harm.
Voluntarily stopping eating and drinking to hasten death is completely legal, safe, and commonly practiced, especially by the elderly who become exhausted by living and wish to be in control of their death.
It is however, slow – 5 to 14 days on average – and can be uncomfortable unless appropriate comfort care measures are provided. One should not engage in VSED without doing research on the process, as in this article, and arranging for supportive caregivers.
There are many illegal ways to hasten one’s own death. All involve some degree of covert action, possible violence to self, and often unresolved grief for the survivors. I choose not to mention these. Many of you are survivors of extreme measures.
Instead, I support Compassion and Choices and Death With Dignity. Both of these organizations are working to give every American who is known to be dying within six months or less the choice of a safe and legal option to hasten their death and end their suffering while supported by loved ones and in the care of hospice.
TERMINAL OR PALLIATIVE SEDATION
Terminal or Palliative Sedation is a last resort treatment offered within hours or days of death. It provides a release for unbearable pain and distress that is unmanageable after all efforts have been made with standard palliative medications. The intention is to put the patient in a deep sleep until they die. Terminal sedation is legal in all 50 states.
PHYSICIAN AID-IN-DYING (PAD)
The ethical principle of autonomy, the right to make decisions for oneself, and the human need for self-determination (isn’t “no” one of the first words a child learns?) has been driving a growing movement to increase options at end of life. Physician Aid-In-Dying or PAD provides legal protection for doctors who are willing to prescribe life-ending medication to eligible patients in order to spare them needless suffering and often violent deaths.
For instance, in Oregon, PAD helped 29-year old Brittany Maynard, avoid tremendous physical suffering. PAD allows an individual to control the timing of death, in a location of choice, surrounded by loved ones.
The legal climate for Aid-in-Dying is Changing. As of this writing, Oregon(1994/1997), Washington (2008), Vermont (2013), California (2016) and Colorado )2016) have laws in place. The Montana constitution protects the practice. On November 8, 2016, the DC Council passed a bill to create a law supporting PAD. Nineteen more states have bills in their legislatures.
Americans want more options for care at the end of life—whether or not they use them.