THE HOSPICE COOPERATION PROJECT

SEEKING BETTER COOPERATION BETWEEN
  the HOSPICE MOVEMENT
  and the RIGHT-TO-DIE MOVEMENT


OUTLINE:

1.  BACKGROUND FACTS ABOUT HOSPICE AND THE RIGHT-TO-DIE

2.  SOME QUESTIONS FOR PERSONS INVOLVED IN BOTH MOVEMENTS

3.  HOW HAVE HOSPICES IN RIGHT-TO-DIE STATES
            RESPONDED TO THEIR RIGHT-TO-DIE LAWS?

4.  COOPERATION NOT CONFRONTATION

5.  HOW WOULD THE HOSPICE PROGRAM YOU KNOW BEST
            RESPOND TO ANY LIBERALIZATION OF LAWS
            CONCERNING THE RIGHT-TO-DIE?



THE HOSPICE COOPERATION PROJECT

SEEKING BETTER COOPERATION BETWEEN
  the HOSPICE MOVEMENT
  and the RIGHT-TO-DIE MOVEMENT

by James Leonard Park

    The hospice movement and the right-to-die have different historical roots.
But in the 21st century, we might see convergence of these two movements,
beginning with ever better cooperation between them.

    Can we find common ground in caring for the dying?
We might begin by gathering information from individuals
who are involved in both movements.

    Perhaps the practices and philosophy of the hospice movement
are converging with the practices and philosophy of the right-to-die movement.

    Do you agree with the following statements of our two philosophies?

    Hospice philosophy and practice seeks to help dying persons
have a peaceful and pain-free last few weeks or months of life.

    Right-to-die philosophy and practice seeks to help dying persons
to choose the best pathways towards death for themselves.

    If these two approaches to dying are really this close,
why not seek closer practical cooperation between our two movements?



1.  BACKGROUND FACTS ABOUT HOSPICE AND THE RIGHT-TO-DIE

    Medicare pays a reasonable amount of cash for each day of hospice care.
The exact amount depends on how terminal care is provided.
And most other forms of health insurance also have a hospice benefit.

    Hospice care can be given in any of the following forms and settings:

(1) Hospice care can be given at home by volunteers and professionals
who visit the patient at any residential location.

(2) Hospice care can be given at a free-standing residential facility.
In this case, the patient is moved to a bed in the hospice building.

(3) Hospice care can be given within another kind of health-care institution,
such as a nursing home or a hospital.
In such cases, the hospice care might be in a separate wing or ward.

(4) Or the hospice care can be given within the same nursing services
which are also caring for patients who are expected to recover.
In this case, the patient does not have to be officially declared terminally ill.
And the nursing care can gradually shift
from attempting to cure the disease
to comfort-care for the patient who is acknowledged to be dying.
In this case, the terminal care might not be called hospice care.

    The right-to-die movement also has several forms and settings
in which to serve individuals in the last days of their lives.

    For example, the End-of-Life Consultation of Compassion & Choices
helps persons who have terminal illnesses in several ways.
Here is the national website of Compassion & Choices:
https://www.compassionandchoices.org/eolc-consultation/

    One sign of the convergence of the practices of the hospice movement
and this part of the right-to-die movement
is that nation-wide about 90% of clients served by Compassion & Choices
are also receiving hospice care at the end of their lives.

    This suggests that there is already considerable cooperation
between the organizations paid to give terminal care
and the population of dying persons
who seek the help of Compassion & Choices. 



2.  SOME QUESTIONS FOR PERSONS
            INVOLVED IN BOTH MOVEMENTS

    Is it correct to assume that operating hospices
must be very cautious about their public image?
Even if they do permit the full range of legal options at the end of life,
perhaps they do not officially want to discuss their openness
to the more liberal and perhaps controversial choices for the end-of-life.

    The Minnesota Network of Hospice & Palliative Care
is an umbrella organization for hospice programs operating in Minnesota.
Their website http://mnhpc.org has now dropped all references to
"euthanasia" and "physician-assisted suicide",
which might signal a subtle shift in policy.

    Everywhere in the world where modern medicine is practiced,
the following four methods of managing death are permitted:

1. providing comfort-care only

2. inducing terminal coma

3. withdrawing curative treatments and life-support systems

4. giving up water

See "Four Medical Methods of Managing Dying":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-L-END.html
These methods of dying might be applied in a right-to-die hospice:
"Methods of Managing Dying in a Right-to-Die Hospice".
We can choose our pathways towards death
using any combination of these methods of dying.
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/METHODS.html

    If you have experience with hospice programs anywhere in the world,
as a board member, staff member, volunteer, or family of a client:
What end-of-life options are offered?
Does the hospice program you know best
encourage or discourage any of the methods mentioned above?
Does the 'culture' of any particular hospice program
make it easy to ask for liberal end-of-life options?
Would the hospice program you are most familiar with
be a good choice for people who wish to exercise their right-to-die?

    If that hospice was established by some religious organization
or is staffed by employees and/or volunteers
who predominantly come from one religious tradition,
how does this affect what actually happens within that program?

    Would the hospice program you know best
resist getting a reputation for allowing liberal end-of-life choices?
They might worry that allowing induced terminal coma, for example,
might discourage potential clients who would never consider that option.

    Does this hospice have written policies concerning
what will be permitted and what will not be permitted under that program?
And beyond any written policies,
what actually happens in the last days of clients
who are enrolled in that program?

    Perhaps different hospice board members, staff members, & volunteers
operating within the same hospice program
have different philosophies and different practices.

    If this is so, how do clients discover the most appropriate helpers
—those staff members and volunteers
who are most in-tune with the patient's philosophy of living and dying?

    For example, if the official philosophy is that there will be no practice
that either lengthens or shortens the process of dying,
will some individuals 'look the other way'
when a patient and/or proxy chooses to shorten the process of dying?
Or if the official policy says that there will be no 'aid in dying',
have some doctors, nurses, chaplains, volunteers, etc.
cooperated in deaths that might be close to helping patients to die?



3.  HOW HAVE HOSPICES IN RIGHT-TO-DIE STATES
            RESPONDED TO THEIR RIGHT-TO-DIE LAWS?

    Hawaii, Washington, Oregon, California, Colorado,
Vermont, Maine, & New Jersey are the first states in the USA
to enact laws that empowers dying patients
to choose to shorten their process of dying using lethal chemicals.
These laws allow terminally-ill patients to request life-ending chemicals
for the purpose of achieving a peaceful and painless death.
There are careful safeguards in place
to prevent mistakes and abuses of this method of choosing death.

    How have hospice programs operating in these states
changed their operating philosophies and practices
in response to these new laws?
Perhaps some hospice programs are more cooperative than others.
The laws do not require health-care providers
to cooperate with the right-to-die laws.
Doctors, nurses, & hospice programs can opt-out
of any practice they reject for philosophical or religious reasons.

    Because the Oregon Death with Dignity Act
has been in effect since the middle 1990s,
all hospice programs in Oregon have decided
whether or not to cooperate with this end-of-life choice.
The right-to-die law in Washington State came into effect in July 2009.
Have long-established hospice programs in Washington state
cooperated with their right-to-die law and procedures?

    Applying for permission to use life-ending chemicals should not mean
that the patient will be excluded from any hospice program
or expelled from any program in which he or she was already enrolled.

    When the care is being paid by the Medicare hospice benefit,
there might be problems using gentle poison to cause immediate death.



4.  COOPERATION NOT CONFRONTATION

    As stated in the title of this project,
we are seeking greater cooperation
between the hospice movement and the right-to-die movement.
Neither needs to change its philosophy or practices to suit the other.
But we might be able to find common ground on which to cooperate.

    Each hospice program is an independent organization
or part of a health-care system that is independent.
Gathering information does not seek to change
the philosophy or practices of any hospice program.

    However, when other states
propose to change their laws concerning the right-to-die,
this will be an opportunity for each hospice program to decide
to favor, oppose, or remain neutral about the proposed legislation.

    And if a change of law is actually enacted,
then each hospice program in the affected states will have to decide
how to respond to any new pathways towards death
that have been opened by new laws.

    As happened in all the early right-to-die states in the USA,
any new laws in other states are likely also to include provisions
allowing any health-care personnel and/or institutions
to opt-out of any practices authorized by new laws.
Each hospice program controls its own philosophy and practices.



5.  HOW WOULD THE HOSPICE PROGRAM YOU KNOW BEST
            RESPOND TO ANY LIBERALIZATION OF LAWS
            CONCERNING THE RIGHT-TO-DIE?

    Would the hospice program you are most familiar with
readily revise its philosophy and practices
to allow the patients to obtain and use chemicals
that would bring their lives to an immediate, peaceful, & painless end?
How would the hospice program you know best
respond to new options for shortening the process of dying?

    Or even earlier, would the hospice program you know best
resist any such change in state law?
Or would the hospice program remain neutral about liberalizing laws?
Perhaps in order not to alienate main-stream clients,
the hospice program would not take any stand
concerning whether laws should be revised
to permit patients to end their lives in new ways.

    Probably some people involved in any particular hospice program
would favor changing the law concerning the right-to-die.
And some people would be opposed.
What are the proportions in your estimation?
The citizens of Oregon ultimately voted 60/40 in favor of their present law,
which allows voluntary death.
And the voters of Washington State voted 59/41 in favor of their law.
In 2016, the voters of Colorado voted 65/35 to create their new law.
The citizens of your state might divide more equally on this issue.
How would hospice workers divide themselves on this question?



AUTHOR:

    James Park is an advocate of the right-to-die with careful safeguards.
The most relevant links to other information
about proposed right-to-die hospice programs appear below.

    This essay about better cooperation has become
the first chapter of Right-to-Die Hospice:
"Seeking Better Cooperation between
the Hospice Movement and the Right-to-Die Movement".

    Much more information about the author will be found on his website,
which is the last link below.

WOULD YOU LIKE TO MEET OTHER SUPPORTERS
OF RIGHT-TO-DIE HOSPICE?

Since you have read this appeal for better cooperation
between the hospice movement and the right-to-die movement,
you might be interested in reading a whole book
exploring how a right-to-die hospice could be established.

The essay above has become the first chapter of Right-to-Die Hospice.

If you would like to discuss the basic principles for a right-to-die hospice service,
consider joining a Facebook Group and Seminar called Right-to-Die Hospice.

Here is a complete description of this on-line gathering:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/ED-RTDH.html

And here is the direct link to our Facebook Group:
Right-to-Die Hospice:
https://www.facebook.com/groups/145796889119091/


The above proposal for better cooperation between hospice and the right-to-die
has also become Chapter 46 of How to Die: Safeguards for Life-Ending Decisions:
"Seeking Better Cooperation between the Hospice Movement and the Right-to-Die Movement".

 
Created April 3, 2006; revised 9-22-2007; 11-21-2008; 3-12-2011; 10-19-2012;
1-2-2013; 1-11-2013; 3-30-2013; 6-1-2013; 4-28-2014; 5-19-2014;
7-10-2015; 10-3-2015; 12-22-2015; 12-26-2015; 1-16-2016; 1-19-2016;
12-13-2017; 4-13-2018; 9-6-2018; 5-28-2020;

Full-Spectrum Hospice
Proposed Policy Statement on End-of-Life Options

    This is a proposed policy statement for a hospice program
that chooses to offer the full-range of legal choices at the end of life.


Methods of Managing Dying
in a Right-to-Die Hospice
We can choose our pathways towards death
using any combination of these medical methods of managing dying.
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/METHODS.html


Safeguards for Making Life-Ending Decisions
in a Right-to-Die Hospice Program
How the 26 recommended safeguards for life-ending decisions
might be applied in a right-to-die hospice
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/HOS-SG.html


Good Death Hospice:
Creating the First Right-to-Die Hospice
Establishing right-to-die hospice programs.
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/GDH.html


How to Die:
Safeguards for Life-Ending Decisions
This on-line book explores all 26 recommended safeguards.
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/HTD.html


Portal for the Right-to-Die
leading in other new directions
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/P-RTD.html




Go to the beginning of this website
James Leonard Park—Free Library