End-of-life care: Pain control carries risk of being called a killer

End-of-life care: Pain control carries risk of being called a killer - amednews.com: The growing use of hospice and palliative care is creating more opportunities for misunderstandings, experts said. New developments in end-of-life care — aggressive pain and symptom management (even to the point of unconsciousness), along with a greater willingness to withdraw advanced, life-sustaining treatments such as mechanical ventilation, dialysis, and artificial hydration and nutrition — still strike many people as wrong.

The distinction between aggressive pain control or the withdrawal of life-sustaining treatments and euthanasia is still lost on many patients and families. Doctors who care care for dying patients should take into account the public’s lagging understanding of end-of-life treatments, take time to explain their intricacies and make use of ethics consultation services.

Related:

“Prevalence of Formal Accusations of Murder and Euthanasia against Physicians,”Journal of Palliative Medicine, March (www.ncbi.nlm.nih.gov/pubmed/22401355/)

“Opinion 2.201 — Sedation to Unconsciousness in End-of-Life Care,” American Medical Association Code of Medical Ethics, adopted June 2008 (www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2201.page)

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To go gently into that good night: When quality of death can enhance quality of life

Globe and Mail: Andrée Hoffman lay on a gurney, the outline of her body visible under a floral comforter. Her daughter Basia Hoffman, in her 50s, was a few feet away, playing Beethoven's Moonlight Sonata on the piano, hours after her 90-year-old mother's death. No one was in a hurry to go to the funeral home.

When the time finally came, those who loved Ms. Hoffman gathered around her body for a procession through the halls of Toronto's Kensington Hospice to the front door. In her final days, the staff had given her oxygen to ease her breathlessness, narcotics to help with pain and baths to keep her clean. They even cooked breakfast for her family – the scent of pancakes and eggs lingered in the air, a smell of home.

“You almost feel guilty,” said Basia's sister, Tatiana Hoffman, 56, “because they make it so beautiful and wonderful. But I feel so much relief she is out of pain.”

Texas hospital starving patient against family wishes

Texas hospital starving patient against family wishes | Spero News: Texas Right to Life denounced the decision by physicians to allegedly eliminate hydration and feeding of a patient under their care in a Texas hospital. According to the group, the hospital has refused to allow the patient and his family to take him to a nearby hospice for care.

Update: Patient dies after hospital denies treatment

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Caring Coalition conference

Hospice of Michigan is once again privileged to sponsor the Caring Coalition conference, March 21 at Shaarey Zedek, in Southfield. This year's theme, "On My Terms: Patient Directed Care," and the featured speaker is Dr. Ira Byock, renowned author and expert on issues related to death and dying.

Pray for the Farrans

Kyle and Heather Farran are missionaries in Richards Bay, South Africa, working with AIDS patients through the Calvary Care Center hospice. Please pray for Heather who is recovering from a bout of mononucleosis and for Kyle as he is suffering with severe headaches.

AIDS hospice report

Farran family with 2 patients (images used with their permission)

Kyle and Heather Farran report about the Calvary Care Home in Richards Bay, South Africa: "As an amazing testimony to God’s grace and provision our first patient was admitted November 1st. Indeed, He 'is able to do far more abundantly than all that we ask or think,' and we echo the words of Paul: 'to him be glory!' (Eph. 3:20-21).

"God has answered your many prayers by blessing us with wonderful caregivers that love the Lord. Heather trained caregivers for two weeks in patient care and I went over the Zulu Bible teaching material that we use (numerous times we have arrived to find the caregivers going through the material with the patients). Patti Buvia, who arrived in September, has been a much needed help in overseeing caregivers during the start-up process.

"It is exciting to see the patients receiving the love and care that they so desperately need. Most importantly, they are being taught the life giving message of the gospel. Each day I am teaching chronologically through the Bible, highlighting man’s need for a Savior and showing the necessity of repentance and faith in Christ. What a joy today to hear both women express that they understand the gospel and have faith in Christ!"

Calvary Care Home dedicated October 2nd!

Missionary Kyle Farran reports: 

"Last week marked an exciting landmark for Calvary Care Home in Richards Bay, South Africa. On October 2nd Calvary Baptist Church held a special dedication service, committing the work to the Lord and thanking Him for His provision. The building is now complete; all that remains are some finishing touches (installing mirrors & paper towel holders, altering curtains and donated sheets, etc.) Patti Buvia arrived from the States on September 22nd to help us during the first year the Care Home is open.

"We have also hired four caregivers who Heather [Farran] will start training next week. One of the caregivers is pastor Clement’s wife. Needless to say, we are thrilled to have her be a part of the ministry. Thank you for praying as we searched for the right workers for Calvary Care Home. All of the caregivers have come by personal referrals and we are so grateful for who God has brought us. Lord willing, we hope to begin taking our first patients at the end of October! Truly, God 'is able to do far more abundantly than all that we ask or think' (Eph. 3:20)." Learn more

Farran Prayer Letter

Farran Prayer Letter: Kyle and Heather report, "PTL! Operating expenses for the Care Home in Richards Bay, South Africa, are covered for the first year." Continue to pray because they need to raise ongoing operating expenses.

Mother's death puts Dr. Kevorkian in perspective

When the doctor gave her the bad news in her hospital room, he asked her if there was anything she wanted. Her immediate response was, "Dr. Kevorkian." At first, I thought it was her idea of a sick joke.

But it wouldn't be long before I knew she meant business. She was soon moved to a hospice care center, where the nursing staff managed to get her well enough to send her home, which turned out to be a cruel move. In a day's time, her condition worsened, and she ended up in a nursing home, where she ultimately died. Our family was told the whole dying process would take two or three weeks, and my mother wouldn't suffer. She would, the doctors said, be asleep most of the time.

The doctors were wrong on both counts. Although they did a fairly decent job of keeping her physical pain at bay, they couldn't do anything about her emotional pain. . . . Unlike dementia patients, my mother was totally lucid until the day before she passed away and knew exactly what was happening to her each step of the way. And during what seemed like every hour of every day, she would say to anyone who would listen, "Get me Dr. Kevorkian." Or, "Give me a poison pill." NWI Times


Editor: I don't know what kind of "hospice" program treats a woman as they did. The perspective of this article is skewed by a misunderstanding about hospice care. 

Specialists call for more focus on hospice

Specialists call for more focus on hospice | Detroit Free Press | freep.com: Jack Kevorkian gets widespread credit as a lightning rod who forced a nation to discuss needed improvements in end-of-life care. But specialists say that the nation's best-known suicide doctor did not provide a dignified death to those who sought him out and didn't do enough to refer people to hospice organizations that could have alleviated their suffering. 'I believe he could have taken his empathy, sympathy and compassion and led people to resources that could have ended in a more dignified death,' said Laura Wagner, chief hospice officer for Great Lakes Caring.

Latest edition of Life Matters features LIFT

Is AIDS a death sentence or a life opportunity? Find out how Kyle and Heather Farran are meeting the challenge in the most AIDS-ridden spot on the planet. Life Matters

November issue of Caring Right at Home

Test Your Brain Health IQ

Caring for Alzheimer's Caregivers

Indoor and Outdoor Falls: Are the Risks the Same?

November is National Hospice Month

Oregon hospices are uneasy dealing with physician-assisted suicide

Oregon hospices are uneasy dealing with physician-assisted suicide - Los Angeles Times: In 1995, Oregon passed a bill legalizing physician-assisted suicide. However, a new study shows a major stakeholder in terminal illness -- hospices -- rarely participate in physician-assisted suicide.

Editor: Which is as it should be.

Bid on an hour with Chef Duff for Hospice of Michigan

Share an hour with Ace of Cake's ® Chef Duff this September in Grand Rapids, MI. You and 9 of your friends can talk food, recipes and anything else with the Food Network's ® chef celebrity. Signup and bid often to win this once-in-a-lifetime opportunity to kick back with a cake guru and reality TV star. Hospice of Michigan

Bringing Doctors to the Dying Patient’s Bedside

In a new initiative to humanize doctor-patient relations, pairs medical students with patients who are dying alone. As described in the New York Times, the two-year-old project is part of a center for humanism that seeks to promote "dignity and respect for the individual, commitment to the relief of suffering and the delivery of care that is kind, just and humble."

Proper Palliative Sedation Not Same as "Terminal Sedation"

The assisted suicide movement is ever about blurring vital distinctions and deconstructing crucial definitions. One target has been the proper pain control technique known as palliative sedation, a rarely required procedure in which patients near death are sedated to control pain or other symptoms such as severe agitation or air hunger that cannot be alleviated in any other manner. Confusion about this–some of it intentionally sown by assisted suicide advocates–induced the National Hospice and Palliative Care Organization to issue a statement clarifying the proper methods and purposes of sedation as a palliative technique. LifeNews

Mum wanted to die

. . . but convincing her to live gave us both a gift beyond measure. Daily Mail

Editor: Watch out for objectionable images on the page

Grace before dying

Louisiana has some of the toughest prison laws in the nation, where one of every 55 residents is behind bars -- many of them for life. At the Louisiana State Penitentiary, a maximum-security facility in Angola, some 85 percent of the 5,100 inmates are expected to die in incarceration. Until recently, that was a lonely process: prisoners were buried in shabby boxes in numbered graves. But in 1998, Angola prison created a hospice program that officials say has been transformative. Newsweek

Hospice Study Finds Racial Disparities

Among patients with advanced heart failure, blacks and Hispanics are less likely to receive hospice care than whites, researchers found. The data are consistent with previous examinations of hospice use, and the findings "counter speculation that overall increases in the availability of hospice services in the 1990s may have erased racial and ethnic differences in hospice use." More research is needed to determine the underlying cause of the disparities. Medical News

Bunny's Last Days: When Living Will Isn't Enough

Palliative care specialists, relatively new players on the health care scene, offer comfort, support, pain control and, if requested, spiritual counsel, helping them sort through often confusing and ambiguous medical options. Unlike hospice care, which requires patients to forgo aggressive medical care, palliative care allows patients to continue any level of medical care they desire. They help people make tough decisions that are less about dying than about how they want to live at the end of their lives. Kaiser Health News