Hospice is the answer to many of today's medical, economic and ethical issues

BECKWITH The ongoing national conversation about the future of health care has included thoughtful questions about quality at the end of life. Is aggressive medical care for someone at the end of life really in the best interest of the patient? Should society be obligated to pay for treatments that ultimately are of no real benefit to a person who is dying? Ethical issues such as these must first be addressed on a personal, individual level, and then be considered as part of the national need to provide and sustain improved, affordable health care for all Americans.

Hospice — caring for people in life's final chapter when there is no cure — offers useful insight and practical answers.

A recent study at Dartmouth University found that, "The end of life is one place where ethics and economics can still be braided into a single strand of humanity." The study found that hospital patients with serious conditions who were treated very aggressively — more tests, procedures, specialists, and more days in the hospital — do not live any longer or experience a higher quality of life than patients who are not treated as aggressively. In fact, the research indicates that patients who are treated more aggressively are at greater risk of infections and medical errors.

In another study, researchers found that patients who chose hospice care lived an average of one month longer than similar patients who did not choose hospice care. They cited several factors that may contribute to longer life among patients who choose hospice. One consideration is that patients who are already in a weakened condition avoid the risks of aggressive over-treatment when they make the decision to receive hospice care. Another factor to consider: Hospice provides in-home care from an interdisciplinary team that addresses emotional needs, spiritual well-being, and physical health — focusing on the person rather that the disease — helping to tie together the important components that contribute to quality of life.

Yet another study, this one from Duke University, tells us that hospice services actually save Medicare dollars while delivering quality care to patients with life-limiting illnesses. In fact, the Duke researchers found that hospice reduced Medicare costs by an average of $2,309 per hospice patient; additionally, for 70 percent of those patients, Medicare costs are reduced even further when hospice is used for a longer period of time. According to the researchers, "Given that hospice has been widely demonstrated to improve quality of life of patients and families... the (hospice) Medicare program appears to have a rare situation whereby something that improves quality of life also appears to reduce costs."

Even more important to me than academic research are the lengthy conversations I have had with the family members of hundreds of people in hospice care over the years. They all wish that their loved ones had been in hospice care much earlier rather than later. Regardless of their medical coverage or other circumstances, Hope gave the families and their loved ones the same loving care that everyone receives at Hope. With an issue as important as end-of-life care, economics must never be an obstacle. In our case, compassion and ethics always come first; morally, it is the right thing to do.