People Want to Live
This study is unsurprising to me: A survey of colo-rectal cancer patients finds that they are more willing to take chemotherapy, even with a small potential for extending life at the cost of significant adverse side effects, than doctors thought would be the case. But when it is your life, you want to keep up the fight. People want to live and they are often willing to put up with the debilitations of chemo to gain a few extra weeks or months.
Unfortunately, this desire to "keep fighting" often keeps patients from accepting hospice care until it is too late to receive most of the benefits, which is a shame given the potential for great help that hospice--properly applied-offers. When I interviewed the late Dame Cecily Saunders, the founder of the modern hospice movement, she criticized this aspect of the US hospice system. She claimed that it creates the appearance of a "one-way street," sort of an "abandon hope all ye who enter here." As a consequence, she told me that (at the time of our interview, circa 2000), the USA had a 15% hospice usage rate versus the UK's 65%.
I agree and it's a shame. When my father was dying of colon cancer we had hospice and it was of tremendous help both to my dad and the entire family.
posted by Wesley J. Smith @ 2:05 PM
4 Comments
4 Comments:
Can't give up on hospices do to a few that seem to have gone south. Thanks deep toad. Dad died back in 1984. He was a great man.
I serve on the ethics commitee of a Hospice. They have had patients that have been given such good care that the patients improved and were probably no longer terminal.
Wesley, I know you've said some positive things about Hospice Patients' Alliance. But they are pretty generally negative about U.S. hospices. It's from them that I've heard about the prevalence of major doses of Atavin and morphine together with no or few fluids. They were pretty vocal at the time of the Mae Magouirk case (shortly after Terri Schiavo's death), where a non-terminal woman was admitted to hospice and became severely dehydrated before being rescued by an agreement between her relatives to take her to a hospital. She was rehydrated there, ended up eating by mouth normally, and lived a relatively normal life in a nursing home for several months before dying suddenly of a stroke. HPA basically gave the impression that this kind of thing isn't all that uncommon in hospice, that once you are designated "terminal" by some doctor or other, you're just sort of expected to be heavily drugged and then to eat and drink little to nothing, even if this is just because of the level of the drugs given.
I gather that you think this is overblown, or that such practices vary too widely from one hospice to another for generalizations, or...?
Indeed, lydia: I am far less skeptical about the general level of hospice care than is the Alliance. It does some good advocacy in cases where abuses are occurring. But although Ialso hear the stories, I still believe that the overwhelming of hospices and hospice workers have the best interests of their patients at heart and do not engage in unethical practices.
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