Not so long ago, the last stage of human life was a personal, familial, or religious affair. Today, 90 percent of the 40 thousand Minnesotans who die each year, do so while under medical care.
Though dying has become increasingly “medicalized,” each death is a story, not a case. It is a personal and family story of profound choices, of momentous words and telling silences, and of acts of caregiving and abandonment that are recounted by the dying person’s loved ones from one generation to the next. Physicians appear in these stories sometimes as stalwart expert counselors, sometimes as high-tech disease warriors, and sometimes as ill-equipped or missing-in-action.
This reference guide will help physicians use hospice to improve end-of-life health care. Hospice is a tool that we do not use often or early enough.
Hospice is not for every dying person. There are times when valiant efforts to forestall a premature or unanticipated death are warranted. But most patients die after a long and ultimately losing struggle with chronic and progressive or terminal diseases, diseases like cancer or heart disease or Alzheimers disease or AIDS. High-quality, end-of-life care often requires more than “do not” orders and good primary care. These patients have special needs for pain control, to have dying occur under the direct care of supportive (and supported) loved ones, or to have intensive and sustained palliative care that is nonintrusive and effective. For them, the multidisciplinary and specialized care of hospice is most likely the answer.
As a trusted counselor, you are the key to the timely referral and use of hospice to improve end-of-life care.