Hospice & Palliative Care: “two evolving options.”
As use of technology increases at end of life patients spend
longer periods of time in medical facilities at the end of life. At the same
time 80% of people, according to the pastoral guidebook for end of life
ministry being proposed to the 222nd General Assembly of the PCUSA,
express a preference for dying at home. Hospice
makes that possible.
The goal of medical care is to “cure illness or extend life.”
The guidebook points out that in efforts to achieve that goal sometimes medical
treatments mean that quality of life in the present is sacrificed for more time
later on. Hospice, as an alternative, helps those with terminal illness enjoy
life to the fullest in the present while relieving pain and promoting awareness
for as long as possible. This is helpful information, not only for pastors, but
for families seeking to understand what it means to put a loved one into
hospice.
“Hospice is a program not a place.” Is another piece of
critical information noted in the guide. A hospice program can take place at
home or in a residential facility. Medicare and most insurance plans cover it
although room and board charges may be additional. Hospice programs do not include
treatment aimed at curing an underlying terminal illness (e.g. chemotherapy).
Other things I have learned about hospice by by reading this paper include:
- It is a team effort and the patient may choose either a personal physician or a hospice physician to guide their care.
- One can be referred by a physician or self refer
- Access to hospice programs is limited to those expected to live 6 months or less
- Hospice teams provide emotional and educational support to patient and family and even help with paperwork, funeral planning and ongoing bereavement support following death.
- The median stay in U.S. hospice programs is less than one month.
- Hospice can be a time of personal and family growth.
In differentiating between ‘hospice’ and ‘palliative care’
it is important to note that hospice programs may include palliative care, but
palliative care can also be provided in conjunction with treatment (e.g. chemo
or radiation). Palliative care provides support to patient and families, seeks
to manage symptoms of chronic or terminal illness and to improve quality of
life.
Advance Directives
Advance directives is a legal document (or documents) that
specifies the types of medical care an individual desires and/or names who will
make those decisions. There are two common forms:
- A living will – specifies the patient’s desire for forms of care, medications for pain, and resuscitation instructions.
- A durable power of attorney for healthcare (not the same as a general power of attorney which gives another person authority over business affairs) designates a proxy (or primary and secondary proxies) to make decisions if (and only when) a patient is unable to express those decisions themselves.
It is important in planning advance directives to think
carefully about your own priorities and goals for the end of life. Is quantity
of life more important to you than quality of life? Do you have goals or family
events with which an aggressive treatment program would interfere?
Communication with family, proxies, one’s physician, and
pastor are encouraged and it is may be wise to provide them with copies of your
advance directives.
Although it is not
mentioned in the paper, there are sources offering uniquely Christian forms of
advance directives that serve as a witness to your faith in God’s sovereignty
over your life and death (e.g. (http://www.christianliferesources.com/index.php/medical_directives)
which offers state by state forms).
Comments
Post a Comment
All comments are reviewed before they post.