Hospice perspectives on death and dying as natural events

Hospice View of Death and Dying as a Natural Event

Some diseases prove to be too strong for medical science to eradicate within the body.

The popular treatment for terminally ill patients is to enroll into a hospice.

Yet, this has created a negative reputation.

Despite any common public misconceptions of hospice care, the true philosophy behind hospice methodology is based on a peaceful understanding of a natural event within the life cycle.

Popular Misconceptions of Hospice Care

Entering hospice care as a negative sign of giving up.

This conception scares both patients and family members from considering using the hospice services.

Therefore there is a negative stigma associated with entering into hospice care.

True Hospice Philosophy

The actual philosophy behind hospice care revolves around accepting the natural life cycle.

Part of that natural cycle is death.

That the individual at hand should be the focus of the care, beyond anything else.

Hospice Methodologies

Focusing on "the person instead of the disease," (American Cancer Society, 2008).

Focuses on alleviating pain as a way to be comfortable during this last experience.

Includes the support and involvement of family members as a way to further comfort the patient.

Benefits of the Hospice for the Patient

Sometimes normal treatments become more of a burden to the quality of life of a patient.

It is in no way a white flag, if a patient were to show signs of improvement he or she could be re-introduced into treatment.

It also provides the family time to enjoy their loved ones.

Conclusion a.. Death is a natural part of life, and hospices services, although different from traditional methodologies, prove beneficial in dealing with death.

Hospice View of Death and Dying as a Natural Event

Not every disease has a cure. Some diseases prove to be too strong for medical science to eradicate within the body. What do we do when faced with a truly terminal disease? One answer was the creation of the St. Christopher's Hospice in England in the 1940's, (Harrison, 2007). This institution relied on the care of individuals for their physical and mental comfort rather than the continuation of treatment meant to strictly fight the disease at the behalf of the patient's comfort. Since its first inception into the U.S. In the 1970's, the popular treatment for terminally ill patients in the United States is to enroll into one of a variety of hospice care methods, yet this association with death and dying has given hospices a negative association. Yet, despite any common public misconceptions of hospice care, the true philosophy behind the hospice methodology is based on a peaceful understanding of a natural event within the life cycle itself.

However, with this popularity has come several negative connotations which have been a deterrent of support from many within the community. There are many misunderstandings associated with hospice care and philosophy which are related around the idea that the patient is throwing up the white flag and giving up. When a patient does decide to stop treatment and enter a hospice program, it is commonly mislabeled as a negative experience, rather than the true intention of hospice care. This misunderstanding has placed a negative and almost morbid label on many people's perceptions of what a hospice is and how it functions. Potential patients as well as family and friends are scared when the idea of hospice care is brought up in many individual cases. It is a very hard decision to deal with, however it is not to be seen as a hopeless endeavor. Due to many individual's lack of understanding of death as a normal stage in the life cycle, the idea of sheltering the dying seems like a scary conception.

However, this idea of death as a natural part of life is the major element within the philosophy of hospice care. The philosophy behind the treatment of methodologies used within the hospice care "affirms life and does not hasten or postpone death," (American Cancer Society, 2008). This is not to be seen as a negative thing, for the philosophy rests on the idea that everyone dies at one point. Death is a natural part of life, and therefore it should be addressed and prepared for in the event that treatment has failed to promise the patient a return to normal life, hospices promote "understanding and accepting that the journey of life eventually leads to death, and encourages people to view this experience as an opportunity for growth," (Harrison, 2007). Part of the idea behind the life cycle is also the belief that the individual is at the center of that cycle and should be the one in charge of decisions made about their own bodies and treatments; the hospice "Promotes self-determination, as patients and families participate in their plan of care," (Harrison, 2007). When the individual, along with the advice and support of their physicians and family decide that a hospice is the best route that individual is taking a huge step in accepting the fact that life is not always forever, and treatment is not always a miracle cure.

At a certain point unique for each individual, treatment for various terminal ailments becomes more of a burden to the patient's comfort during the final stages of life. When the decision is made to stop treatment of a patient by a collaborative belief that the treatment is doing nothing more than prolonging pain within the patient, that individual has the option in entering into a hospice program. The various types of hospices offer patients around the world a more peaceful way to relieve their pain, rather than fight their disease through treatment, "The goal of hospice is to enable patients to continue an alert, pain-free life and to manage other symptoms so that their last days may be spent with dignity and quality, surrounded by their loved ones," (American Cancer Society, 2008). The hospice, then helps prepare for the future, while at the same time catering to the present to make life more comfortable for the patient.

There are several key factors which would influence a physician to advise a hospice care program over continuing traditional medical treatments. Traditionally, if a patient has received a prognosis of six months or less to live, a physician might recommend hospice care, (Help Guide, 2008). Fortunately, hospice services are offered around the country and have become affordable to many patients in need of their services. According to Health Guide, the cost of hospice care is actually lower on average to the cost of inpatient care in a traditional treatment methodology. There is no age or ailment requirement, for it is truly a decision to be made by the patient and his or her immediate family members. However, a decision to enter hospice care is in no way permanent, and a patient can choose to re-renter traditional treatments at any point.

One of the major elements of hospice philosophy is the idea to treat the individual over traditional medicine which focuses on the disease. While most medical organizations rush for the cure, hospice staff and volunteers rely on their focus on the individual patient's needs and wants in their care; they narrow down their focus to "the person instead of the disease," (American Cancer Society, 2008). Most traditional Western medical treatments aim to preserve the longevity of human life. Hospice care, however, is much different; "it focuses on quality rather than length of life," (American Cancer Society, 2008). However, at this point within the patient's life, treatment has been abandoned in hopes of making life easier to handle for those who will do not have much life left in their prognosis, "Care has to be individualized to meet the patient's and the family's needs, as well as being responsive to differences in lifestyles," (Harrison, 2007). This ***** from traditional Western medical approaches is meant to signify that the disease or illness if no longer the focus of the treatment. All medical efforts now center around the wants and needs of the individual patient, both mentally and physically. Therefore, the disease is not even a concern for hospice volunteers and staff members nor should it be for the patient of the family as well.

Pain is the major concern within hospice treatment. The major factor which makes hospice care differ so drastically from traditional medical treatment is the use of palliative care, (Harrison, 2007). In this methodology, pain is the main attack of hospice care. Treatment is administered, not to cure the disease, but to prevent it from causing unbearable amounts of pain which would further jeopardize the patient's quality of life during the hospice process. Palliative care "includes physical, psychological and spiritual comfort delivered by a multidisciplinary staff," (Harrison, 2007). Therefore traditional Western medicine used in terms of pain management is combined with other holistic methods of comforting the patient spiritually and mentally. Hospice care involves a variety of staff members who specialize in a range of fields, including counseling, traditional medicine, and spiritual matters. This is meant to effectively give the patient all the comfort and care he or she might need during a stay within the walls of a hospice. In fact it is federally mandated that hospices must give the patient every option available to them in order to efficiently manage pain, "the federal guidelines regulating hospice require the hospice to make every reasonable effort to assure that the patient's pain is controlled," (Hospice Patient's Alliance, 2008).

Hospice services are sophisticated and rely on a number of professionals to help comfort and ease the pain of patients who have chosen to enter into a hospice care program. There is an entire structural hierarchy of care professionals which is designed to help the patient and family members along every step of the process. First and foremost comes the immediate medical staff which will be making medical decisions in regards to pain management and other forms of medical treatments. These staff members include doctors and trained nurses. Physicians are responsible for administering effective pain management methodologies, and are therefore very important in the structure of hospice care, (Help Guide, 2008). Along with the necessary decisions of pain medication, further medical staff is needed for everyday involvement of the patient's life and comfort. Nurses are the professionals who have the most hands-on responsibility for patients within the walls of inpatient facilities. Bereavement counseling and support is also offered to both patients and family members as needed throughout the entire process. This form of counseling can be obtained wither at an inpatient center or through programs which place the patient at home to be cared for.

Another route a patient can choose to take is at-home care. Services called "Home Health Aides and Homemaker Services," (Help Guide, 2008) are offered to assist family members in the in-home care of patients currently enrolled in hospice care programs. These professionals enter into the patient's home to check on conditions and needs, as well as to assist the family in anyway they are needed. Some at-home professionals can also provide life in services which take some of the responsibility of everyday care out of the hands of family members, so they can enjoy their loved ones without having to be involved in the physical needs of the patient. The family plays the largest role within the care of patients who have chosen to stay at home during their treatment. Family members then become responsible for creating a comfortable atmosphere as well as keeping the patient up-to-date with their medications and other treatment needs. However, this intensive care can prove to be a lot for a family to deal with. Therefore, many hospice programs also offer a type of temporary inpatient facilities in order to give the family a "breather," (Help guide, 2008). These programs are commonly known as respite care, and are designed as temporary inpatient services to help take some stress off of the family members who are otherwise involved within the everyday care of the patient.

There are several ways in which pain management within a hospice setting differs from traditional methodologies of pain management. Many of the medications used within hospice care would not traditionally be prescribed for normal pain management. In traditional cases, physicians tend to shy away from strong narcotics unless directly needed due to risks of later addiction and other serious complication. However, within the setting of a hospice, addiction is not a worry for physicians, "Addiction is a problem for those who are not dying," (Hospice Patient's Alliance, 2008). Therefore, they prescribe stronger pain management narcotics without fear of the risks which would pop up in normal medical situations. It is also important to decide which medications should be administered to each individual patient. Pain comes in many forms, not all of which will respond to the same pain medication. Therefore, doctors must choose carefully which medications to be administered based on a case by case basis. If the wrong medication is chosen, there may be unwanted side effects which in fact make the patient's state of life worse rather than better, "Increasing the dose of a medication which is not appropriate does not help, and only increases the adverse side-effects which good medical management tries to avoid," (Hospice Patient's Alliance, 2008). Making the patient as comfortable as possible is the basic fundamental principle of hospice philosophy, so why should any doctor prescribe medications which would only worsen the condition of the patient? The idea behind medication within a hospice setting only further strengthens the idea that each individual is the true focus of the treatment.

Another major element in hospice methodology is the implementation of the family into the care practice. In order to provide the most comfortable experience for the patient involved in the program itself, hospices provide "family-centered care and involves the patient and the family in making decisions," (American Cancer Society, 2008).

Family members are encouraged to participate within the daily routines of care. In many cases, the hospice care is set within the home of a family member. This not only proves beneficial to the patient, but also to the family involved within the care of that said patient, "Care is provided for the patient and family 24 hours a day, 7 days a week," (American Cancer Society, 2008). Research has proven the beneficial nature of family involvement within hospice treatment and decision making. Many hospices around the globe offer family members a key role within decision making, in order to help encourage the decisions made by the frail patients who are in question. Due to the patient being at the center of treatment, the family is essential in the decision making process. However, some research has shown that family members are not as active as they should be, leaving much of the decision making on the patient, which is sometimes unfair.

In many cases, the family is more directly involved with the patient remaining at the home of a family member during the hospice care. In fact, a majority of cancer patients decide to involve themselves within hospice care at the home of a loved one, with family members taking the highest role within their treatment and comfort needs. Many patients are offered the option of receiving hospice care from a variety of professionals, volunteers, and family members from the comfort of their home or the home of a loved one. This at-home care offers the best way to provide the comfortable and relaxing atmosphere while dealing with the final stage of the life cycle, without sacrificing true medical professionalism. As already seen, pain management is the utmost concern for hospice patients, and so patients who decide to undergo hospice care at a residential home must continually stay in contact with their physicians and nurses. There are several reputable Hospice Service providers which aim at maintaining the professionalism of an in-house facility, but within the comfort of one's own home, (Help Guide, 2008). It is in the home where the family becomes the patient's biggest allies in the entire process. Therefore, many cases are recommended to enter into a hospice care program which is centered within the family home. This provides a loving atmosphere for the patient, while integrating constant family contact which is sometimes lost at an in-house facility.