Are Physicians Ethically Obligated to Address Hospice as an Alternative to “Usual” Treatment of Advancing End-Stage Disease?
Hospice care is ideally suited to meet the psychosocial and spiritual needs of dying patients, providing the opportunity to settle financial, property and inheritance issues; to mend lacerations in important lifetime relationships, including forgiving and asking forgiveness; and to assure a degree of autonomous control over the environment and the social and spiritual processes that attend one’s death. Physicians are not only imprecise in prognosticating a patient’s time till death; they tend to be over-optimistic in their predictions. A “NO” answer to the question, “Would I be surprised if this patient died in the next year?” is a reasonable starting-point for discussing Hospice care as a potential treatment plan, now or in the futureFor patients who are failing, with declining prospects for 1-year survival, physicians have a duty to present palliative care in Hospice as an alternative to the recurrent hospital interventions that are typical in the last 6 to 12 months of life.
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