Hospice Is Still The Answer – by Richard B. Fife

To sum up:

The definition of physician-assisted suicide: With physician-assisted suicide (PAS), following a patient-initiated request, a physician provides the means for the patient to end his or her life. Typically, the physician offers counseling, information and instruction, prescribes (and sometimes delivers) medications but does not otherwise participate in the final act. The presence of the physician during the suicide process is sometimes encouraged, but remains a matter of physician and patient preference.

The conditions promoting consideration of PAS are generally physical suffering, emotional suffering, social suffering and existential suffering (hopelessly worsening quality of life). The proponents of PAS as a therapeutic option in end of life care have offered four major reasons as compelling justifications for their position: 1) Inadequate or unavailable pain and symptom management; 2) Autonomy and privacy: the patient’s right to choose (case studies of Quinlan, Cruzan, Schiavo and others); 3) Perception of being a burden; and 4) Existential suffering.

There have also been four major arguments against PAS. 1) Patient autonomy is not limitless. Individual patient rights must yield to the overall societal concern for the sanctity of human life.; 2) PAS is a “slippery slope” leading to social injustice and depravity; 3) PAS is incompatible with the role of the physician as healer and protector of life. In this view, PAS is seen as a violation of the Hippocratic Oath.

In previous blogs, I have addressed those three concerns. It is the fourth argument with which I would conclude this series. 4) Improved access to adequate hospice and palliative care in most cases obviates the need for PAS. A model for quality end of life care for the terminally ill is already available. The real debate should be about improved access to hospice and palliative care programs. Although there are about 3000 hospices in the United States, the quality of hospice care is variable; and there are millions of people in this country who do not have access to hospice services. Funding restrictions and overly restrictive and rigid interpretation of the Medicare rule mandating a life expectancy of six months or less have placed restraints on the ability of many hospices to respond appropriately to need, and have resulted in a majority of patients being referred to hospice less than a month before death. With education and legislative changes, hospice care could markedly reduce suffering in almost all terminally ill patients. Hospice could provide pain management, spiritual support, physical presence and a real alternative to PAS. Hospice is still the answer.

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