Hospice at Christmas Time

Ron Panzer
Reproduced with Permission
Hospice Patients Alliance

You know, November was National Hospice Month and a lot of other things, according to those who decide these things, but my wish this Christmas is that hospice would be hospice, what people expect from hospice and what it's supposed to be. It's a wonderful thing when you're sick, to have someone who helps you and cares for you, but you wouldn't understand that if you haven't been sick or haven't seen someone suffer deeply. But if you were or are now ailing, or have seen suffering, you know what a great thing it is to feel someone's caring touch help you or help the one you love.

This Christmas, I don't have to wish upon a star to get what I want, but we do need the help of others who feel the same. We need doctors, nurses, social workers and hospice directors who remember the mission and work to make hospice what it was supposed to be. We need them to reinvigorate the hospices that exist already and to renew the mission so many have dedicated their lives to fulfilling.

Today (December 12, 2011) a hospice medical director called me and we spoke for about an hour. She confirmed that she's seen the hospice killings, the intentional overdosing, the sedating without reason and the really pathetic care that gives every patient the same treatment masquerading as that wonderful thing that hospice is supposed to be, was, and is today in some cases. Any physician working in the hospice industry sees evidence of it, either at one hospice or another. And physicians who do not work in hospice also see evidence of what is going on, when they regularly see patients who were not imminently dying, die shortly after entering the hospice.

It was inspiring to hear from a physician who knew what it meant to give just the right amount of medication for a specific end-stage disease and not give that treatment for someone suffering from a completely different terminal illness. I thank God for physicians like her, that she even exists, but somewhere in northern America, at the very, very large hospice where she worked, some people didn't like her stopping the killings and they asked her to leave!

What an incredible tragedy, that the physician who made it her business to be there at any time for her patients, would be asked to leave so that the "hospice" could pretend to be hospice and rake in money, switching out patients with the same kind of efficiency as changing oil at the Quick Lube when their time was up (and discarding them with the same disdain). Only the staff at this hospice weren't even waiting till the patients' time was up. They made death happen and the doc was upset about it. It was clear that the National Hospice & Palliative Care Organization had a lot to do with this particular hospice (I know it does) and that the administration has made it a business rather than a place with a mission the people can respect.

Well, that's what we need to look at, the mission of hospice. The mission to care for each patient as an individual, doing what will ease their suffering, however that may be done, while never hastening death. Death will come whether we want it to or not, and we can't cure what can't be cured yet, so we don't have to even try that. That's basic hospice.

But hospice is a playground for nurses or doctors who want power. Power to kill, and power to control. Nurses have very little supervision from physicians and often are working alone, just reporting to a physician who has to trust the nurses (as should be the case) that when they report the patient is in extreme pain or terribly agitated, that that actually is what is happening. Unfortunately, as the doctor reported, some nurses weren't telling the truth. They were making up stories about the patients' conditions to get the orders they wanted. When the doctor checked up, the nurses were upset they were found out.

This gal, the physician? When a patient who was getting closer to the end said he just really wanted to go fishing? She up and took him fishing, and they caught a lot of fish! That kind of thing is what makes hospice a special niche within health care, and what makes the other niches special, too, when nurses, doctors and other professionals take the time to do the ordinary things with care and do the extraordinary with just the same care, to go the extra mile rather than sitting at a desk reading a magazine or playing some computer game when the patients are calling out for help.

To know what hospice is about, you have to know what a patient is, what an illness is in particular, how to treat it, and what all of this is really about. I guess that applies to most anything, any business, but especially hospice. A patient is a real man, a real woman, a person before you who is in need. The illnesses vary and each has a very different type of treatment that helps. You don't need to be afraid of those patients, though many would be afraid, you just need to be yourself. You do need to be educated and there are plenty of references that describe the individualized treatment that goes with an end-stage heart failure patient as contrasted with a lung cancer patient or an AIDS patient. The treatments are very different, even in hospice. The Palliative and End-of-Life Care: Clinical Practice Guidelines is one example of several available.

Patients don't want our pity. They don't want to be patronized, "honeyed," or fake-loved. They want reality. Matter of fact honesty and professional care. That will do it just nicely. Thank you very much! And those who are killed often are not even given any choice in the matter. It's easy for a family or staff member with an agenda or an inheritance to gain to impose death in this setting.

The doc agreed that you could have patients who were overdosed with opioids like morphine, and bring them back using Narcan, titrating it, adjusting it to the point where the patient recovered. Clear to both of us that if the patient was "really" dying, as the nurses said, that patient wouldn't have come back no matter what you did. Clear as can be, the proof is that the patient lived, and this doc had brought patients back from time-to-time. Obviously, the patient wasn't "dying" dying, but was just overdosed. Of course, the nurses who pushed death and pretended they weren't? ... they didn't like it. They really didn't like it, being exposed like that. "We don't kill patients, they all said." But they did, and they are.

You can't tell what kind of patient you have just by looking at them. You can't tell what they did, what their history was, whether they were a judge, an attorney, physician, mechanic, salesman, manager or farmer, just by looking. When you get old or really sick, you're just a human being, like all the rest of us, without all the fluff, the "robes" of power, whether a judge's black robes or a physician's white coat, etc. You're stripped of all that, you're just a person in need.

You can't tell what kind of physician or nurse you have just by looking at them, either. You've got to ask questions and find out what kind of worldview they have, what their philosophy of life is, even what their religious outlook is. Because nowadays, you can't assume that those with the white coats are going to care for you or even tell you the truth. You have to observe their actions and see what the results are. If their actions honor the life of the patient, then you've got someone who serves the real mission of hospice and palliative care: to relieve suffering at the end-of-life while not imposing death.

There have always been those who take pride in mistreating others, bullying them, exploiting them, enriching themselves while pushing others down. Some slave masters thought nothing of whipping or even killing a slave who disobeyed or became inconvenient in some way. Even though slavery is outlawed in the United States, there is probably more slavery today than ever before, it's just hidden in some societies of Africa, the Mideast, and elsewhere, even the United States: slaves to labor in sweat shops or fields or sex slaves. Greed and evil have continued the abominable practice of devaluing others and treating them like objects, even property.

A great and dedicated advocate for freeing the slaves in the 1860s South, Fanny Kemble wrote in her Journal,

"I have sometimes been haunted with the idea that it was an imperative duty, knowing what I know, and having seen what I have seen, to do all that lies in my power to show the dangers and the evils of this frightful institution."

That is how I feel about the problems in the hospice industry and the involuntary medical killing of vulnerable elderly and disabled patients occurring in our nation. The abuses of slavery were openly known by those directly involved and victimized, but not spoken about in the South's "polite society." The abuses of the health care system are openly known by those directly involved and victimized, but not spoken about at all in the major media today.

At the end-of-life, there are some who look at patients like objects, things to be manipulated and managed, not people with a soul. Physicians or nurses who think this is all there is, who don't believe there is any purpose in life if you're suffering are much more likely to hasten your death than those who have a spiritual outlook and believe life is a gift from the Creator.

If you treasure life and understand the purpose of life, even if there is suffering to be relieved, you are not going to be imposing death. What you do as a hospice professional is going to be entirely different, something wonderful, something that families will remember for the rest of their lives when they remember their loved one's last days.

It's not like the people around don't want what hospice has to offer. They just don't want what is being offered in too many places today: stealth euthanasia. I hear from them all the time. Patients, families, friends and caregivers. It's upside-down, just like most of society today. Doesn't make any sense that the health care niche that made its name on being compassionate, looking to help heal relationships at the end, and allow for that healing to take place, that this niche, hospice, would obliterate everything it's supposed to be about and just kill off patients (even if it's a "slow" two-week (terminal sedation) death being imposed), but that's exactly what's happening, and the doc confirmed it. ... just like so many others I've spoken to over the past fifteen years.

You wouldn't know it if you looked anywhere in the major media today. You wouldn't know it if you looked at the advertising and PR that continues to be spouted by hospices all across the country. But it's the truth. And sure, this will offend a whole bunch of hospice people who are either killing people and don't want it exposed, or who aren't and don't want to believe what others are doing.

Just like the National Right to Life Committee (even with all the good it has accomplished). It's leaders are pretty ticked off that we've exposed their coverup of the hospice killings that many hospices have been engaged in for over a decade. You see, it's not how much money these big nonprofits (whether pro-life or pro-death) bring in that really matters at all. It's what they do with it.

Their mission statement? They're "devoted to disseminating information and support for pro-life issues." Well, if blocking information about the hospice killings is "disseminating information," then are we just supposed to lay down and say, "ok?" Really? When an organization this prominent says nothing about such a huge issue, their claim to be "the" voice of the pro-life movement becomes hollow and they make themselves irrelevant to the discussion.

If you take in millions, and pay your chief executives over $100,000 per year, that's fine so long as you do the smallest thing, ... and that is to tell the truth and honor life at every turn, but that's too much for them. That pledge they say in court about telling the "whole" truth, "nothing but" the truth is important. Telling part of the truth, or a tiny fraction of it, and leaving out the most important part just doesn't serve the public well.

And the National Hospice & Palliative Care Organization? Similar story. It has long ago abandoned the mission to promote real hospice care. No matter how much hospices do right, if they end up killing patients, it destroys the very thing they're set up to do.

Now, the NHPCO is big business, even if it is "nonprofit," in the business of promoting other businesses: the hospice agencies (mostly for-profit nowadays). That's what a trade organization does, but they forgot the mission. They lobby government and promote their industry. What about what's best for the patients, the families, the staff? The mission? Hello? It isn't killing patients.

What is the mission? To care for each patient at the end-of-life providing unique clinically-indicated care for each patient, depending upon the actual conditions presenting at the time. Nothing more, nothing less. But as the doc confirmed, many patients just get the same old sedation and morphine. She said, so long as she was there giving care that allowed patients to "live life fully" as Dame Cicely Saunders said, till a natural death occurred, other docs in town would refer to the hospice. She had to struggle to get other staff members to follow simple medical orders to only give medications that were really needed, but some staff sedated patients to make it easier to do their job or because they had an agenda.

As soon as other physicians in the area realized she was gone, they wouldn't refer to the hospice until the patient is already very close to the very, very end. They just don't trust the hospice with its "euthanasia" flavor of hospice. And they don't want their patients dying as soon as they are referred to hospice when the patient just received a terminal diagnosis and really do have months more, not hours or days, to live.

This hospice? It's a really big hospice, well-known throughout the country, at least in the hospice world, so it just confirms for the hundredth time what we who've been watching the industry know: the "Third Path" or "Third Way" of medical killing through the misuse of terminal/palliative sedation is widespread in the hospice setting.

Well, this Christmas I wish that hospice would just be hospice, what it really is supposed to be, what people expect it to be and what they deserve to get. I think that would be a wonderful gift this year. And the young doc, I wish her all the best, because I know she'll be doing her best to ease the pain of someone, somewhere this Christmas and for many years to come. And maybe, more patients will go fishing, and live, and be here with their families till the time comes. And that will be all right, because they got good care along the way, and knew they were loved till the end. Like my Dad, who passed away at the age of 92 in late November, ... he's ok.

Isn't that what Christmas is really supposed to be about? Caring for each other, peace on Earth, good will toward all men and hope in the One who gave us this life?