Contact: Managing Editor Lisa Veglahn, [email protected]
and Palliative Care Against a Backdrop of Evolving Legal, Medical, Business, and Social Realities
In this volume of scholarly and personal work, end-of-life care professionals and those with an interest in medical ethics will find perspectives that both inform best practice and challenge current approaches to care for those with life-threatening illnesses.
Chapters explore topics including the limitations of the Medicare Hospice Benefit (MHB); equitable access to care; use of telehealth in end-of-life care and bereavement support; medical aid in dying; voluntarily stopping eating and drinking; guiding surrogate decision makers; pain management; pediatric hospice care; and developing and training hospice ethics committees. (View the full table of contents here.)
A prominent theme addressed by book authors and editors is whether hospice, a comprehensive service that answered a collective public cry for non-medicalized death decades ago, has lost its ethical footing and moral compass as a result of its dramatic shift to a largely for-profit business model.
“With more than 70% of providers now for-profit, is hospice being transformed from a social reform movement into a financial strategy? Is hospice today fated to being driven by return-on-investment margins rather than by ethical missions devoted to patient-centered dignity and respect?” ask editors and ethicists Timothy W. Kirk, PhD, City University of New York, and Bruce Jennings, MA, Vanderbilt University, in their foreword.
Since the 1983 enactment of the MHB, Americans have benefitted from hospices’ team-based, patient-and-family centered approach to care for the dying, and today, more than a million people in the US die in the care of hospice each year. The benefit has allowed patients with a prognosis of six months or less to die in their homes, where most want to die, and it has enabled (and required) people to die without life-prolonging or futile medical interventions. Yet after 40 years, several authors agree, it is time to revisit the rigid benefit structure of hospice within the context of its founding principles, the needs of terminally ill patients, and modern medicine.
“We need to ask ourselves whether, in today’s medical landscape, the restrictions around hospice care that force such binary choices are reasonable or appropriate any longer, or whether the ethos of person-centered care—care that aligns with patient’s goals and values—is instead directly challenged by hospice as it stands,” writes Alexis Drutchas, a palliative care physician at Massachusetts General Hospital.
Available now, the book is part of HFA’s ongoing educational initiative to increase awareness of hospice and care for the bereaved. End-of-Life Ethics in a Changing World is available to order on HFA’s website, www.hospicefoundation.org, or by calling 800-854-3402.
