END OF LIFE QUESTIONS WE MUST ALL CONFRONT:
HOSPICE CARE OR CONTINUED TREATMENT FOR TERMINALLY ILL PATIENTS
By Fanny Shwartz
Hamlet's monologue asks the famous determining question "To be or not to be”. This classic question could easily be applied to end of life care, as “to treat or not to treat”: At the end of life, is it best to suffer slowly, i.e., to prolong life with painful treatment that will ultimately prove futile, or to accept death as a natural part of life’s cycle. This subject is much in the news because the debate over Medicare benefits and health care reform has aroused public concern. Medicare, as a vital part of our health program, consumes a major portion of government expenditure. This makes sense, since it is the elderly who are the neediest beneficiaries.
Currently, there is much debate about end of life measures. How much treatment should be extended to the terminally ill? This is a soul churning question that has no definitive answer. A certain faction believes that ceasing treatment is wrong even if treatment will ultimately be futile. Other medical practitioners lean toward palliative care that is aimed at reducing pain and suffering, and making the patient as comfortable as possible as the end draws near.
This is not a question that can be answered solely by doctors or by the government. The patient and the family must make the determination. Mr. X doesn't want to give up. He accepts pain and suffering believing that miracles happen. Mr. Y is weary and tired of fighting death. He no longer wants care. Each must be entitled to pursue his decision.
Hospices and home care services offer a humane, compassionate and cost effective option for patients and their families as they face end of life choices, and provide a comprehensive care network which allows terminally ill patients to die with dignity.
Hospices require that certain criteria must be met in order to qualify for treatment. A patient must be declared by a doctor to have six months or less to live, and the patient must agree not seek active medical treatment while in hospice care.
The emphasis in hospice care is on comfort and family participation. Hospice participants include nurses, social workers, home health aides, clergy, and volunteers. Medicare covers most hospice services entirely, and some hospices may provide services without charge if patients have limited resources. Information on coverage by Medicare, Medicaid or private insurance can be retrieved from your physician or social worker. Much preliminary information may be retrieved off the internet (see links below).
Hamlet wondered "whether 'tis nobler in the mind to suffer the slings and arrows of outrageous fortune or to take arms against a sea of troubles" When faced with end of life decisions, only your conscience should guide the ultimate resolution.
HelpGuide.org, Hospice Care: End of Life Care at Home or in a Hospice Facility (many questions answered on the definition of hospice care and how to pay for it)
Fanny Shwartz is a retired English teacher with a Master's degree from New York University. She currently lives in Los Angeles and volunteers at the Broad Stage in Santa Monica.