What Is Hospice?
Hospice and Palliative care are often used interchangeably, but they are actually quite different. Palliative care is a type of medical care that focuses on “providing relief from the symptoms and stress of the illness.” (https://www.capc.org/about/palliative-care/). This can improve quality of life for both patients and caregivers, and people can receive palliative care whether they are focused on living as long as possible (longevity) or they are focused on maximizing their quality of life without pursuing longevity-focused medical interventions (comfort care).
When people are no longer focused on longevity-focused medical interventions, but strictly want to improve quality of life by aggressively providing relief from symptoms, a change in the approach to medical care is happening, and this approach is called a “comfort care only” plan. This means that no more life-sustaining interventions are attempted, so people refrain from things like IV fluids, IV antibiotics, CPR, intubation, blood draws or blood products, surgeries, and dialysis. Instead, the focus of comfort care is to provide relief from symptoms.
Often in these situations, people typically get involved with Hospice. Hospice is a medical service that is a Medicare benefit (and often private health insurances). As a service, Hospice is intended to faithfully honor the comfort care plan by paying for those medications that provide symptom relief, durable medical equipment, bereavement services, and extra support from physicians, nurses, chaplains, and social workers. Sometimes, fears about Hospice become a barrier to enrollment, and these fears are occasionally driven by spiritually appropriate concerns, three of which will be addressed here:
Is the Hospice philosophy at odds with my faith tradition?
When individuals who are deeply rooted in spirituality seek comfort, it is often sought through God by means of their faith tradition. Some view a difference in their spiritual beliefs and the hospice philosophy (Rhodes, Batchelor, et al., 137).
The goal of Hospice is not to replace one’s hopes and source of comfort from God, but rather to serve as a means to provide that comfort, and many even view that service as one that is sent by God (Noh and Schroepfer, 294).
As such, by assisting with the medical side of things, Hospice as an extra support may allow family, friends, and faith community to be with the individual. In other words, it can serve as a way to allow others to visit the sick (Matt 25:35). By offering the lowest effective dose of certain medications, physicians hope to alleviate the symptom burden and ease the suffering of one who is dying (Prov 31:6-7).
Would enrolling in Hospice mean giving up on my faith?
In situations where one might be hoping for a miracle, there can be a perception that enrolling in Hospice would be tantamount to giving up on the faith (Reese, Smith, et al., 496). Yet the power of prayer does not disappear when someone is on Hospice (Rhodes, Elwood, et al., 515). Even when God is “calling someone home,” so to speak, God is Immanuel; God is with us through the dying process. That miracle can still be anticipated and hoped for in the new heavens and the new earth.
Does Hospice care hasten death?
Believe it or not, some studies have shown that Hospice can actually prolong life (cf. Duggan, Duffus, et al.). Experiences can feel very different from that reality, however. Many times, families associate the use of medications with the dying process instead of the condition from which someone is dying. However, correlation does not equal causation. People receive medications like morphine because their symptom burden indicates its use. The underlying condition is both the source of the symptom burden and the cause of death, not the morphine.
A heavy symptom burden can cause an extraordinary amount of stress on the body (for example, a rapid heart rate), which could potentially shorten one’s life. Relieving those symptoms can actually decrease those stressors. Hospice providers are trained to provide the lowest effective dose to alleviate symptoms, the goal being comfort rather than unconscious or sleepiness. As the body shuts down, people sleep more frequently and are less responsive as death becomes more imminent, whether or not they have medications to relieve suffering.
An opportunity to collaborate
As we care for those in our community, whether for our neighbor or someone in our faith community, we have the opportunity to come alongside families as they make difficult decisions. If you are in leadership in your faith tradition and would like to collaborate with our Hospice team and receive more education regarding Hospice care and its philosophy, we would love to be able to provide a forum to provide that and also build opportunities to better serve Monroe County.
If you are interested, please contact us at jonathan.steiner@rochesterregional.org.
Bibliography
Center to Advance Palliative Care. “About Palliative Care.” Accessed 05/21/2024. https://www.capc.org/about/palliative-care/.
Duggan KT, Duffus SH, D’Agostina RB, Petty WJ, Street NP, Stephenson RC. “The Impact of Hospice Services in the Care of Patients with Advanced Stage Nonsmall Cell Lung Cancer.” J Palliat Med. 2017;20(1).
Noh H, Schroepfer TA. “Terminally Ill African American Elders' Access to and Use of Hospice Care.” Am J Hosp Palliat Care. 2015;32(3):286-297. https://pubmed.ncbi.nlm.nih.gov/24413609/.
Reese DJ, Smith MR, Butler C, Shrestha S, Erwin DO. “African American Client Satisfaction with Hospice: A Comparison of Primary Caregiver Experiences Within and Outside of Hospice.” Am J Hosp Palliat Care. 2014;31(5):495-502.
Rhodes RL, Batchelor K, Lee SC, Halm EA. “Barriers to End-of-life Care for African Americans from the Providers' Perspective: Opportunity for Intervention Development.” Am J Hosp Palliat Care. 2015;32(2):137-143.
Rhodes RL, Elwood B, Lee SC, Tiro JA, Halm EA, Skinner CS. “The Desires of Their Hearts: The Multidisciplinary Perspectives of African Americans on End-of-Life Care in the African American Community.” Am J Hosp Palliat Care. 2017;34(6):510-517.
Rhodes RL, Teno JM, Welch LC. “Access to Hospice for African Americans: Are They Informed about the Option of Hospice?” J Palliat Med. 2006;9(2):268-272.
About the author
Johnathan Steiner
Dr. Johnathan Steiner completed his Master of Divinity at Northeastern Seminary in 2013. He currently serves as a Hospice and Palliative Care Physician with Rochester Regional Hospital (RRH).