IMMEDIATE RELEASE, June 22, 2005
Illinois Right to Life Committee
Hospice Bait and Switch
William Beckman, Executive Director, 312-422-9300
Have you heard the principle expressed that
hospice care neither artificially prolongs life nor hastens death? This concept of hospice care is prominently
stated on the Hospice Foundation of America web site.
It turns out that this phrase amounts to nothing more than bait and switch
advertising. Practicing buyer
beware is strongly advised.
Foundation of America has published a book entitled Living With Grief: Ethical Dilemmas
at the End of Life. Actions called
ethical in this book are anything but ethical. Buried
in the middle of the book, in a chapter extolling the ethics of assisted suicide (chapter
10), are statements that reveal typical hospice care often hastens death.
is a telling sentence that summarizes the means used to hasten death ( page 192): Although
the ethics of euthanasia is not the subject of this chapter, it is well known that
hastening death is practiced and approved in many ways in contemporary terminal care when
suffering is extreme and irremediable for example, by terminal sedation, by
delivering pain relief sufficient to cause death by incidentally suppressing breathing, or
by withdrawing nutrition and hydration. Given
the obligation to relieve suffering, such practices are not incompatible with the
and irremediable suffering turns out to be nothing more than patient (or caregivers)
concerns about quality of life and dying with dignity. Under the principle of autonomy
patients should have the opportunity to choose suicide when they are rational
in making that choice.
chapter on assisted suicide presents the so-called ethics of assisting the would-be
suicide with the following logic on why the caregiver is not responsible in any way
for the death of the patient: Assisting
suicide does not involve killing others or taking steps that cause or hasten their deaths. Suicides kill themselves. Assistance involves such things as giving would-be
suicides information about how to kill themselves, enabling them to secure the means of
doing so, giving them realistic options, interacting with them as they choose among their
options, assuring them that their choice will be respected, supporting them emotionally
once they have decided, and protecting them from unwanted intervention. The would-be suicides themselves are entirely
responsible for exercising the option and completing the act of killing themselves.
that sound like the same thing as being an accomplice to a crime? If valid ethics have reached such a state, we need
to inform the criminal courts that they can no longer prosecute the person who drove the
bank robber to and from the bank that was robbed. Clearly,
this parallel example shows that what is being called ethical behavior to encourage
patients to kill themselves does not pass the test of either logic or ethics.
Foundation of America puts its name squarely behind this faulty logic to justify behavior
that is not ethical at all. Their reference
to these means to hasten death as contemporary terminal care warns us that
these practices might also be found outside of hospice care. We might be in danger in hospitals and nursing
homes as well, but Hospice Foundation of America is willing to document such practices as
ethical end-of-life care. Beware of the
philosophy of care provided by any hospice, but especially of those associated with this
death is hastened by actions of caregivers or the patient, this is certainly not death
with dignity! The author suggests the same
false concepts of choice that we have heard for years to justify abortion. If you do not accept these actions as ethical, do
not commit suicide yourself or assist someone else, but do not try to prevent others from
exercising their right to die. The
author even goes so far as to claim that not referring would-be suicides to
others who would be willing to assist them would be unethical. That is what always happens when something truly
unethical gets labeled as a right. Wrong
becomes right and right becomes wrong!
Illinois Right to Life Committee
65 E. Wacker Place, Suite 800
Chicago, IL 60601
* * * * * * * *
Illinois Right to Life Committee,
founded in 1968, is the oldest Pro-Life educational organization in Illinois.
ADDITIONAL MATERIAL AND RESOURCES:
Connecting the Dots on End of Life Issues
Involuntary Euthanasia Cases
Threatened: The Need for End-of-Life Activism
IRLC Patient Self-Protection Document
(Life-affirming Durable Power of Attorney for Health Care from
IRLC. It needs changes for use in these states: AK, AL, CA, CT, DE, FL, HI,
IN, MI, MN, MO, NC, ND, NE, NH, NV, OH, OK, OR, SC, TN, TX, UT, VT, WV and WI.)
Treatments and "Vegetative" State (Pope John Paul II)
(check Timeline to
learn about the "right to die" movement's leadership )
National Catholic Bioethics Center
Not Dead Yet
Suicide: The Wrong Approach of End of Life Care
Related material from IRLC Newsline:
Illinois Right to
Life News for Friday, May 6, 2005
Hospice association materials
confirm that hospices hasten death
IRLC has received a number of reports of concern about hospice care. Two nurses have reported specifically that they
have witnessed how hospice care is used to quickly terminate the lives of patients. Hastening death is inconsistent with the
principles stated on the Hospice Foundation of America web site. These principles state that hospice care neither
prolongs life nor hastens death and that the goal of hospice care is to improve the
quality of a patient's last days by offering comfort and dignity.
Recently, one of our members attended a conference called Ethical
Dilemmas at the End of Life sponsored by Hospice Foundation of America. The materials obtained from this conference
express principles that seem inconsistent with the principles just mentioned that are
visibly proclaimed on the web site of this organization.
Some examples from conference materials include:
The right to refuse life-sustaining medical treatment does not depend on
the patients life expectancy or being terminally ill.
Artificial nutrition and hydration is a medical treatment that legally may
be withheld/withdraw under the same conditions as any other form of medical treatment.
Competent patients have a right to refuse medical treatment, even if that
treatment is necessary to sustain life.
The implications of these principles suggest that in practice hospices
have no problem with taking steps that hasten death.
Under their definition of the term, medical treatments to sustain life include tube
feeding, insulin for diabetics, kidney dialysis, and many more. Removal of these medical treatments will
certainly hasten death.
Regarding tube feeding, an article from Hospice Foundation of America on
nutrition and hydrations states There comes a time in some cases where even
nutrition and hydration are considered extraordinary means of prolonging life, and such
ordinary nutrients are discontinued. The
decision to withhold food and/or fluids is made only when it is apparent to the caregivers
and family that further prolongation of life would only extend discomfort.
These statements apply to many more cases than those where the body begins
to shut down and becomes increasingly unable to process nutrients. True medical justification for removal of
nutrition only occurs when body systems are shutting down as death becomes truly imminent. Using a criterion that further prolongation
of life would only extend discomfort is much broader in scope than circumstances
where body systems are shutting down. This
expansive willingness to deny nutrition and hydration is further confirmed when the
article suggests bio-ethical support for withholding nutrition in those persons with
advanced illness whose greatly impaired quality of life would not be improved, but only
Greatly impaired quality of life is a subjective criterion
that can easily be abused in arbitrarily deciding to deny food and water to patients who
are not dying. Any hospice that follows the
principles set forth by the Hospice Foundation of America is certainly willing to
cooperate with or even encourage actions that hasten death through denial of food and
water. They have clearly stated a standard of
care that hastens death in their own literature.
Beyond nutrition and hydration, the National Hospice and Palliative Care
Organization (NHPCO) accepts the use of terminal sedation for some patients. "Terminal sedation is deliberately inducing
and maintaining deep sleep but not deliberately causing death in very specific
circumstances." Terminal sedation (also
called total or palliative sedation) is a protocol actively promulgated by the National
Hospice and Palliative Care Organization (NHPCO).
Howard M. Ducharme, chair of the philosophy department at the
University of Akron, expresses serious concerns about the use of terminal sedation. He writes (copied from http://www.cbhd.org/resources/endoflife/kingsbury-ducharme_2002-01-24.htm):
Terminal sedation (TS) is not limited to patients who
are suffering from overwhelming physical pain from their terminal illness. TS is deemed appropriate for intractable or
refractory suffering due to "overwhelming physical, emotional, or spiritual distress
that is poorly relieved by other means."2
NHPCO advises, "There are many cases in which patients experience refractory
spiritual or emotional pain, often referred to as existential suffering."3 TS
is deemed appropriate treatment for existential distress "that is not relieved by
counseling from social workers and chaplains, psychotropic medications, and other
Thus, the criteria for rendering a patient totally unconscious can come down to the
individual's own report of the existential distress he or she feels. Those suffering from
chronic depression or severe depression (e.g., parents who have lost their only child in a
car accident) would qualify for TS.
When patients are put in an unconscious state through
terminal sedation, they will not be given food and water by hospices that practice this
protocol. Whether a feeding tube is removed
or total sedation is used, the patients will die from starvation and dehydration. In what way is this approach not hastening death?
The issue of pain
control is also being reported as an opportunity for serious abuse in hastening death. Testimony exists that a high dosage of painkillers such as morphine are being
used to hasten death If the morphine
does not cause respiratory failure first, patients will die of starvation and dehydration. Buyer beware is definitely in order with hospice
Illinois Right to
Life News for Tuesday, October 4, 2005
Armed (with morphine) and dangerous
Bruce called me on September 29th. He heard our message about the Patient
Self-Protection Document on WIND 560AM. He
called because he thought he should obtain a copy for his mother. The background that led him to that conclusion is
most disturbing. He witnessed his father
being killed by a hospice nurse using an overdose of morphine. The nurse who came to his fathers house to
provide hospice care actually tried to get Bruces mother to give the morphine, but
she refused. So the nurse gave the overdose
of morphine herself. Bruce said his father
was not even in pain. Having pain would have
been the justification for giving some morphine so there was no justification for any
morphine at all.
That experience seems like more than enough for Bruce to
decide that his mother needs to complete a Patient Self-Protection Document. But there is even more that Bruce is concerned
about. It turns out that Bruces sister
is a hospice nurse. She actually thinks that
she is doing the compassionate thing when she overdoses hospice patients on morphine. She even told her mother about providing morphine
to the children of a 93-year-old man so they could relieve his suffering whenever that
might be necessary. For now, he still drives
and gets along just fine. He happens to be a
friend of Bruces mother. How might she
let him know that his own children are armed with morphine and dangerous if he develops
Bruces mother has told his sister that she should
leave her job as a hospice nurse because she is killing people. How does she face the knowledge that her daughter
is ready to end her life if she gets too inconvenient?
She is legally blind and deaf, but she is still able to take care of
most her needs. Her daughter suggested she
should consider hospice, and she replied that a nursing home would do just fine. This hospice nurse was working at a hospice in the
Elgin area. It would seem that such a hospice
may already be using euthanasia as a standard part of their hospice care with Bruce's
sister as one of their willing agents to perform the deed.
Bruce made an observation based on his experience with
his sister. He said she never came home at
breaks during college, but if someone had an ailing animal to be put to sleep, she would
come right home to take care of it. Now she
apparently thinks human beings should get the same treatment. Bruce thinks she is quite happy with her job, even
though she is dealing with death, and people near death, all the time. He observed that hospice work could easily attract
people who think like his sister.
Illinois Right to
Life News for Friday, October 7, 2005
Assuring skeptics on hospice use of morphine overdoses
As reflected in a response I
received to my last newsline, some of you may be skeptical that hospice could be killing
people. I appreciate your skepticism about
the possibility of nurses using morphine overdoses to kill hospice patients. I was
at that same point less than a year ago. Then I got a call from a nurse who wanted
to share with me that exact fact. A week later I got a call from another nurse who
had the same information to report.
Then I started to
investigate on my own. I was helped when two people I know, one who volunteers at a
hospice, decided to attend a conference on hospice that was held in the Chicago area last
Spring. They were shocked at what they learned at the conference (sponsored by
Hospice Foundation of America). It was very clear to both of them, and further
confirmed in handout materials they received, that hastening death was being proclaimed as
both compassionate and normal procedure for hospice. One could only conclude that
the unstated purpose of the conference was an attempt to convince hesitant medical
professionals and hospice volunteers that hastening death is both compassionate and
This conclusion was fully
confirmed by a book that these women each received a copy of at the conference. The
book is called Living With Grief: Ethical Dilemmas at the End of Life, published
by Hospice Foundation of America. One of them gave me her copy of this book, and
I read it from cover to cover. The book endorses assisted suicide as
practiced in Oregon and clearly suggests that equivalent laws should be
passed in every other state. Hastening death "by terminal sedation, by
delivering pain relief sufficient to cause death by incidentally suppressing breathing, or
by withdrawing nutrition and hydration" are endorsed as "practiced and approved
in many ways in contemporary terminal care." Of course, the second
approach described is a morphine overdose.
I have received additional
calls from people who witnessed occurrences of this practice, including most recently
Bruce. I have also had communication either by phone or email with at least 6-8
people so far who are involved in what can be described as the anti-euthanasia movement.
They have all confirmed that it is a known fact (at least to them; it wasn't
to me yet, but it is fast becoming so) that these practices are being openly used in
Does that mean they are
being used in every hospice? No. I have talked to a number of people who
know people or their relatives who have recently been under hospice care and have
continued to live for a number of months or even still. Those hospices do not use
these procedures to hasten death (because when hospices do use these practices, patients
are often dead in 3 to 5 days after entering hospice care). How many hasten death
versus how many do not? It's very difficult to know, but hospice leadership
organizations including Hospice Foundation of America, National Hospice and Palliative
Care Organization, and others are pushing hospices in that direction.
also received another response. When her
husband needed hospice care, Angie was already knowledgeable about morphine because her
husband had needed it for pain control for two years.
When hospice got involved nine days before her husband died, Angie was
given a schedule for morphine every 2-4 hours, but Angie only gave her husband morphine
once per day until the last two days when she gave two and then three doses, but never
anything even approaching 6-12 doses per day. Angie
wrote, He was never uncomfortable, was coherent to his last breath, and telling his
family he loved God and wanted to be with Jesus.
Her family never allowed him to be left alone with a hospice nurse.
Other families are not as fortunate. In many cases the family
members are innocently giving the morphine per the hospice schedule that hastens death
without realizing what is happening until it is too late, or never knowing the truth.