MORTALITY, MORALITY & HONOR: THE END-OF-LIFE PARADIGM

MORTALITY, MORALITY & HONOR:THE END-OF-LIFE PARADIGM

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DA VINCI’S VITRUVIAN MAN - 1490 VITRUVIUS 25

B.C.

THE CIRCLE REPRESENTS THE

COSMIC & THE DIVINE

THE SQUARE, THE EARTHLY

& THE SECULAR




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THE GOAL: LINEAR TO CIRCULAR THE LONG FLAT TABLE NO LONGER




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ANOTHER “DR DEATH ?” MY MANTRA

GROW OLDER & DIE YOUNG AS LATE AS POSSIBLE

PLAN ON IT

PLAN FOR IT




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AND MY WISH?

TO WRITE MY LAST CHAPTER…. AND WHEN IT IS READ, A LONG TIME FROM NOW, HAVE IT BE RECOGNIZED AS A WORK OF NON-FICTION




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A CONSTANT ? OR AN EVER-CHANGING LANDSCAPE ?

IF YOU WANT TO HIT A BIRD ON

THE WING YOU MUST HAVE YOUR

MIND IN FOCUS. YOU MUST HAVE

THAT BIRD IN YOUR MIND’S EYE.

EVERY GREAT ACHIEVEMENT IS A

BIRD ON THE WING.

OLIVER WENDELL HOLMES Jr




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IF YOU A WANT “BEST” READ A “MUST” READ

ATUL GAWANDE MD

“LETTING GO” NEW YORKER

AUG 12, 2010

WHY NOW ? WHY HERE ?

A BIG ISSUE

A DIVISIVE ISSUE

A “CIVIL” RIGHTS BATTLE

0

2

4

6

8

10

12

What Percent of People Will Eventually Die?

AND IT WON’T BE EASY

GALLUP’S VALUES ANDBELIEFS POLL - MAY ‘10 DWD - PAS 45 % - IT’S MORALLY ACCEPTABLE 32 % - IT’S MORALLY WRONG




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“IT”

THE RIGHT, IN ADULTSOF SOUND MIND, TO EXERCISE CHOICE ANDCONTROL FOR THEM-SELVES AT THE END OFLIFE




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DOES THIS MAKE A DIFFERENCE ?

NATIONWIDE, RECENT POLLS

SHOW THAT >70% OF AMERI-

CANS BELIEVE THAT TERMIN-

ALLY PATIENTS SHOULD HAVE

THE RIGHT TO SELF-ADMINISTER

A LETHAL MEDICATION TO

ACHIEVE A PEACEFUL DEATH.




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I KNOW- POLLS !

‘05 GALLUP75% SAID YES TO DOCTORSBEING ALLOWED TO HELP THE

TERMINALLY ILL DIE

BUT ONLY 58% SAID YES WHEN

THE WORD SUICIDE WAS

INCLUDED




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BUT INCREASINGLY

THE COURTS AND THE PUBLIC

RECOGNIZE THAT TERMINALLY ILL

PATIENTS ASKING FOR AID IN DYING

ARE NOT “SUICIDAL”

AND PROVIDING SUPPORT IS NOT

“ASSISTING SUICIDE.”




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SO WHO IS AGAINST PHYSICIAN ASSISTED DEATH ?

THREE BROAD CATEGORIES:

SANCTITY OF LIFE MUST BE PRESERVED

THE SLIPPERY SLOPE MUST BE PREVENTED

THE MEDICAL SYSTEM CAN ELIMINATE OR

ALLEVIATE END-OF-LIFE SUFFERING




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WITH ALL DUE RESPECT

U.S. CONFERENCE OF BISHOPS –‘11

“ALL PATIENTS – INCLUDING THOSE

IN THE SO-CALLED PERSISTENT VEG-

ETATIVE STATE – BE PROVIDED WITH

ARTIFICIAL HYDRATION AND NUTRITION

IF SUCH CARE COULD EXTEND LIFE, EVEN

INDEFINITELY.”




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CATHOLIC ETHICAL & RELIGIOUS DIRECTIVES – (CERD’s)“VIRTUE IS PROTECTING & PRO-

LONGING LIFE, OVER ALL VIRTUES,

OVERRULING PATIENT CONCERNS

ABOUT THEIR QUALITY OF LIFE.”

“PATIENTS EXPERIENCING SUFFER-

ING THAT CANNOT BE ALLEVIATED

SHOULD BE HELPED TO APPRECIATE

THE CHRISTIAN UNDERSTANDING OF

REDEMPTIVE SUFFERING.”

IRONY TO ANXIETY: 40 % OF HOSPITALS……

IRONY TO HYPOCRISY: IF WE ARE GOING TO A BETTER PLACE ?…..




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THE HIPPOCRATIC OATH

ORIGINAL ENGLISH TRANSLATION:

“I WILL NOT GIVE A LETHAL

DRUG TO ANYONE IF I AM ASKED”

MODERN TRANSLATION:

“I WILL REMEMBER THAT THERE IS

AN ART TO MEDICINE AS WELL AS

SCIENCE, AND THAT WARMTH, SYM-

PATHY AND UNDERSTANDING MAY

OUTWEIGH THE SURGEON’S KNIFE

OR CHEMIST’S DRUG”




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THE MANTRA – THE MYTH

DOES PAD, (DWD), CONTRA-

DICT A PHYSICIAN’S RE-SPONSIBILITY TO PRESERVELIFE? COMPASSION: THE HUMANE QUALITY OF UNDER-

STANDING THE SUFFERING OF

OTHERS AND THE DESIRE TO DO

SOMETHING ABOUT IT




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IRONYWHAT WOULD HAPPEN IF THERE WERE NO MORE DEATH ?

WE WOULD HAVE NO NEED FOR

PROGRESS OR ART, FAITH OR FAME

WE WOULD HAVE LITTLE TO DO

YET IN THE GREATEST OF IRONIES,

HAVE ENDLESS EONS IN WHICH TO

DO IT.

ACTION WOULD LOSE IT’S PURPOSE,

TIME ITS VALUE




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THE “SLIPPERY SLOPE” WILL ADVANTAGE BE TAKEN NO, ABSOLUTELY NOT!

RATES OF ASSISTANCE IN STATES,

(COUNTRIES), WHERE DWD IS LEGAL

SHOW ABSOLUTELY NO BIAS AGAINST

THE ELDERLY

THE UNINSURED

THE UNEDUCATED

THE MINORITIES

THE POOR

A REVERSE SLOPE ? THE W & W - THE D & A




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AND AS FOR COMPLETE RELIEF

LET US ASK WHY PALLIATIVE

CARE HAS EMERGED AS A

RESPECTED & ESSENTIAL PART

OF OUR MEDICAL LANDSCAPE -

ONLY RECENTLY !

COLORADO SB 102 - 2006




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PAIN & COMPASSION (PLEASE REFLECT ON IT)

WHAT ARE WE GOOD AT ?

OUR MEDICAL SYSTEM IS

EXCELLENT AT TRYING TO

STAVE OFF DEATH WITH:

ICU CARE $5,OOO+/DAY

CHEMOTHERAPY $8,OOO/MO

SURGERY $5,000/HR

BUT ULTIMATELY, THE

OWL CALLS OUR NAMES




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AND NOT SO GOOD AT ?

“AGAINST OTHER THINGS IT IS

POSSIBLE TO GAIN SECURITY, BUT

WHEN IT COMES TO DEATH WE

HUMAN BEINGS ALL LIVE IN AN

UNWALLED CITY.”

“NO ONE WANTS TO DIE. EVEN

PEOPLE WHO WANT TO GO TO

HEAVEN DON’T WANT TO DIE TO

GET THERE. YET DEATH IS THE

DESTINATION WE ALL SHARE.”

AND DOES OUR MEDICAL PROFESSION HAVE A PROBLEM WITH THIS ?

JENNIFER TEMEL MD – MGHNEJM 2010

(RANDOM ASSIGNMENT OF 151 ADV LUNG CANCER PTS TO “REGULAR CARE OR CARE & EARLY DISCUSSIONS WITH PALLIATIVE CARE

GROUP TWO:

BETTER QUALIITY OF LIFE & LESS TROUBLESOME SYMPTOMS IN TIME REMAINING

PHYSICIANS SHOWED A BETTER APPRECIATION OF PT’S WISHES & WERE MORELIKELY TO RECOMMEND CARE CONGRUENT WITH THOSE WISHES

FAMILIES SHOWED LESS GUILT & DEPRESSION AFTER THE DEATH.

GROUP TWO LIVED A LITTLE LONGER TOO (2.7M)




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MORE ? - THE KEATING STUDY (CANCER 15 2010)

NANCY L KEATING MD, MPHHARVARD MEDICAL SCHOOL

BY QUESTIONAIRRE, (4,000+ PHYSICIANS CARING FOR CANCER PATIENTS

LOOKED AT TIMING OF DISCUSSIONS ON 1. ACCURATE PROGNOSIS 2.WISH FOR “DNR” 3. NEED FOR HOSPICE 4. PREFERRED SITE OF DEATH CONCLUSIONS:

MOST PHYSICIANS REPORT THEY WOULD NOT DISCUSS END-OF-LIFE OPTIONS WITH TERMINALLY ILL PATIENTS WHO ARE FEELING WELL.

“THERE WILL BE TIME FOR THAT LATER.”

BE ADVISED, TALKING ABOUT DYING WON’T KILL YOU, THOUGH…………………




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A DOUBLE STANDARD ?

“WHY DOCTORS DIE DIFFERENTLY”

KEN MURRAYCAP - FAMILY

MEDICINEUNIV SO CALWSJ 3/10/12




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HONESTY – THE BEST POLICY ?

HEALTH AFFAIRS JOURNAL FEB, 2012 POLL OF 2000 MD’s

MORE THAN HALF HADFRAMED A PROGNOSIS IN A MORE POSITIVE LIGHT THAN WAS WARRENTED




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SIGNS OF CHANGE ?

2011 SURVEY BY THE REGENCE

FOUNDATION ON BEHALF OF THE

NATIONAL JOURNAL FOUND

THE 96% OF MD’s BELIEVE IT’S

MORE IMPORTANT TO IMPROVE

PATIENT’S QUALITY OF LIFE THAN

TO PROLONG THEIR LIVES.

79% OF MD’s SURVEYED SAID:

“U.S. SPENDS FAR TOO MUCH

TRYING TO EXTEND LIVES”




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ALZHEIMER’S DISEASE

“A DEGENERATIVE DISEASE THAT

IS 100% INCURABLE AND 100% FATAL, WHICH ROBS ITS VICTIMS OF MEMORY, JUDGEMENT & DIGNITY, LEAVING THEM UNABLE TO CARE FOR THEMSELVES, AND DESTROYING THEIR BRAIN AND THEIR DIGNITY, OFTEN DEPLETING THE RESOURCES OF THEIR CAREGIVERS AND THEIR FAMILIES – BOTH EMOTION- ALLY & FINANCIALLY.

JUSTICE SANDRA DAY O’CONNOR OCTOBER 27TH, 2010 NY TIMES




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AND A SOBERING THOUGHT

STARTING ON JAN 1, OUR 79 MILLION

STRONG BABY BOOM GENERATION

WILL BE TURNING 65 AT THE RATE OF

1 EVERY 8 SECONDS !

AND THE REALITY IS THAT THE

INCIDENCE OF DEMENTIA DOUBLES

EVERY FIVE YEARS AFTER 65




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KAREN KEHL – Am J Hosp & PC “MOVING TOWARD PEACE” A GOOD DEATH

BEING COMFORTABLE

BEING IN CONTROL

HAVING A SENSE OF CLOSURE

MAKING MOST OF RELATIONSHIPS

HAVING FAMILY INVOLVED




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IN WHICH IS THERE TIME FOR…

MORTALITY, MORALITY & HONOR CHOICES AT THE END OF LIFE




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THE SEMINAL CASE KAREN ANN QUINLAN - 1976

CHRONIC VEGATATIVE STATE

PARENTS REQUEST “WITHDRAWAL”

NJ SUPREME COURT RULES IN FAVOR

OF THE “RIGHT TO REFUSE ARTIFICIAL

VENTILATION”




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KAREN ANN QUINLAN - 1954-1985

THE FATHER, A FIRM CATHOLIC,

AND THE ASSIGNED GUARDIAN,

WAS A POSITVE FORCE IN THIS

CASE, FOR ADDRESSING HIS

CONSCIENCE AND MOTIVATIONS

THE FIRST CASE ABOUT THEOLOGY,

BIOETHICS, EUTHANASIA, LEGAL

GUARDIANSHIP AND CIVIL RIGHTS

POSITIVES: BIOETHICS COMMITTEES

ADVANCE DIRECTIVES




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TERRI SHAIVO – CVS – 1990-’05

ESSENTIALLY, A TRAGEDY:

OF PERSONAL LIVES

OF THE LAW

OF POLITICS

ULTIMATELY, AN EMBARRASSMENT

( READ “USING TERRI”)




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THE HISTORY OF END-OF-LIFE CHOICES IN THE UNITED STATES

‘87, ’89, ’91: OREGON WRITESLEGISLATION GRANTINGINDIVIDUAL OPTIONS FOR END-OF-LIFE (SS FRANK ROBERTS)NO BILL LEAVES COMMITTEE

ROBERTS DIES A HARSH DEATHAT HOME AT LEAST – OCT ‘93

‘94 OREGON PASSES VOTER INITIATIVE TO ALLOW DWD (51 TO 49 %) (SIGNED INTO LAW BY ROBERT’S WIFE & GOVERNOR, BARBARA ROBERTS)

INTERCONNECTIONS

APRIL, ‘93, AT THE PEAK OF THE AIDS EPIDEMIC, ACTIVISTS ESTAB-

LISH “COMPASSION IN DYING” IN SEATTLE, WASHINGTON, PUBLI-

CALLY DECLARING THEIR INTENTION TO COUNSEL MENTALLY

COMPETENT, TERMINALLY ILL PATIENTS ON AID-IN-DYING.

PUBLISHED WERE SPECIFIC ELIGIBILITY CRITERIA, GUIDELINES AND

SAFEGUARDS AND VOLUNTEERS TO ATTEND DEATH.

A MEDICAL MODEL EVOLVES WITH CLIENT ASSESSMENT, PROFES-

SIONAL REFERRALS, AN INTERDISCIPLINARY TEAM OF VOLUNTEERS

AND SELF-ADMINISTERED MEDICATION.


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JUNE, 1997

“THROUGHOUT THE NATION, AMERICANS

ARE ENGAGED IN AN EARNEST AND PRO-

FOUND DEBATE ABOUT THE MORALITY,

LEGALITY AND PRACTICALITY OF PHY- SICIAN AID IN DYING. OUR HOLDING PERMITS THIS DEBATE TO CONTINUE, AS IT SHOULD IN A DEMOCRATIC

SOCIETY.”

Median Age 70 (25-96)

White - 97.5%

Education - 67% had attended college

Suffering from cancer - 81.8%

Enrolled in hospice - 87.8%

Insurance - 98.2%

Sex - 53.1% Male - 46.9% Female

94% died at home

Facts on Use of Oregon Law




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OREGON AT 14 YEARS

I CONTEND NO “SLIPPERY SLOPE”

BUT AN AGING POPULATION

WITH MORE CHRONIC DISEASE

AND MORE KNOWLEDGE




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“REASONS FOR ‘CHOICE’”

LOSING AUTONOMY 89.9 %

CANNOT ENGAGE IN

PLEASURABLE ACTIVITIES 87.4 %

LOSING CONTROL OF BODILY

FUNCTIONS 58.7 %

BURDEN TO FRIENDS 39.3 %

INADEQUATE PAIN CONTROL 23.9 %

FINANCIAL CONSIDERATIONS 2.8 %




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THE “HOW TO”

A TERMINALLY ILL, COGNITIVELY

SOUND ADULT, MAY OBTAIN A Rx FOR A

LETHAL DOSE OF MEDICINE, PROVIDED

THE PATIENT:

1. HAS BEEN ADVISED OF OTHER OPTIONS

2. HAS MADE TWO VERBAL APPEALS / 15D

3. HAS MADE A WRITTEN REQUEST

4. WITNESSED BY TWO WHO ARE NOT

CARETAKERS OR FAMILY

5. ORAL, NOT IV MEDS / HELIUM

OUR GOVERNMENT IN MEDICINE




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OBAMA CARE & “DEATH PANELS”

FROM AN OFTEN CITED PROVISION

OF THE UNPASSED BILL WHICH WOULD

HAVE AUTHORIZED MEDICARE REIM-

BURSEMENT FOR PHYSICIANS WHO

WOULD PROVIDE VOLUNTARY COUN-

SELING ABOUT SUCH SUBJECTS AS

PATIENT & FAMILY WISHES, LIVING

WILLS,

AD’s…………..CHOICES…….. AT THE END OF LIFE




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AH…. WHAT TO MAKE OF IT

BETSEY McCOUGHEY

VP CANDIDATE PALIN “MY PARENTS & MY BABY WITH

DOWN’S SYNDROME WILL HAVE TO STAND IN FRONT OF OBAMA’S DEATH PANAL SO BORED BUREAUCRATS CAN DECIDE, BASED ON SUBJECTIVE JUDGEMENT, ON THEIR ‘LEVEL OF PRODUCTIVITY IN SOCIETY’, WHETHER THEY ARE WORTHY OF HEALTH CARE.”

“NULLIUS IN VERBA”




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THE FALLOUT

STUDIES SHOWED THAT

30 TO 45 % OF AMERICANS

BELIEVED THIS RHETORIC




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MORE GOVERNMENT

JANUARY 1, 2012 – CREATION

OF “INDEPENDENCE AT HOME

ORGANIZATIONS” – GROUPS OF

DOCTORS & NURSES TO Rx PTS

AT HOME & INCENTIVES TO

MAKE THAT WORK APPEALING.

PAID FOR BY SAVINGS FROM

DIMINISHING HOSPITAL STAYS

AND PROCEDURES




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AND AGAIN ?

IN THE AHCA, IN 2014,

THE INDEPENDENT PAYMENT

ADVISORY BOARD, (IPAB),

MAKES RECOMMENDATIONS

ON COST SAVINGS, YET IS

EXPRESSLY PROHIBITED FROM

TAKING ANY ACTION WHICH

WOULD RATION CARE.

BUT…………..




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AN INTERESTING POLL

FIFTY-THREE % OF AMERICANSWOULD JUST AS SOON SEE THEHEALTH CARE BILL REPEALED.FORTY-THREE % SUPPORT IT.

OF INTEREST, 70% OF THE53% OPPOSED, FAVOR 2/3OF THE BULLETS CONTAINEDIN THE BILL.




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THERE’S AN ARGUMENT

ANY CENTRALLY ADMINISTERED

HEALTH-CARE SYSTEM WILL, INEVITABLY,

MAKE “COST-MINDED JUDGEMENTS ABOUT

WHAT TYPES OF CARE” SHOULD BE PRO-

VIDED TO WHICH CATEGORIES OF PATIENT

ALREADY HAPPENING

ARIZONA: THE STATE CUT OFF REIMBURSE-

MENTS FOR ORGAN-TRANSPLANTS FOR THE POOR




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NEVER TALK ABOUT THE COST (BUT BE REMINDED)

25 %OF ALL MEDICARE SPENDING IS FOR THE 5 %OF PATIENTS WHO ARE IN THE FINAL YEAR OF LIFE, AND MOST OF THAT MONEY GOES FOR CARE IN THEIR LAST MONTHS OF LIFE WITH LITTLE BENEFIT IN TERMS OF LONGEVITY OR QUALITY OF LIFE.

(ABOUT 60 BILLION)

AND THE PSYCHOLOGICAL, PHYSICAL AND FISCAL COST TO

FAMILIES ?

OF COURSE, WE DON’T KNOW IT’S THE LAST MONTHS




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CURRENTLY THE LEGAL RIGHT OF EVERY CITIZEN IN EVERY STATE A COMPETENT ADULT PATIENT

HAS THE RIGHT TO REFUSE UN-WANTED MEDICAL TREATMENTTHAT COULD INCLUDE DIALYSIS,SURGERY, BLOOD

TRANSFUSIONS,ANTIBIOTICS AND ARTIFICIAL LIFESUPPORT, EVEN WHEN REFUSALMIGHT LEAD TO DEATH.

THIS RIGHT EXISTS EVEN IF THEPATIENT IS NOT TERMINALLY ILL.




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WHAT ABOUT OUR CITIZENRY ?

“DO YOU APPROVE ORDISAPPROVE OF LAWSTHAT LET PATIENTSDECIDE ABOUT BEINGKEPT ALIVE THROUGHMEDICAL TREATMENT?”

84% APPROVE

PEW RESEARCH CENTER ’01-’05




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WHO’S SIDE ARE YOU ON?(IS IT NOT PART OF OUR LEGAL DNA?)

“THE ROOT PREMISE IS THE CONCEPT,

FUNDAMENTAL IN THE AMERICAN

JURISPRUDENCE SYSTEM THAT EVERY

HUMAN BEING OF ADULT YEARS AND

SOUND MIND HAS A RIGHT TO

DETERMINE WHAT SHALL BE DONE

WITH HIS OWN BODY.”

JUSTICE BENJAMIN CARDOZO

NY COURT OF APPEALS 1914

(US SUPREME COURT 1932-38)




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A DEVIL’S ADVOCATE – MAY I ?

A FEW THOUGHTS ON

END-OF-LIFE PLANNING




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STEPHEN JAY GOULD

BROOKLYN/HARVARD PALEONTOLOGIST

‘85 ESSAY:« THE MEDIAN & THE MESSAGE »

Dx; ABDOM MESOTHELIOMA - ‘85

THE LITERATURE: BRUTAL (8MO’s)

BUT THE CURVE BEYOND THE MEDIAN

WITH A LONG, ALBEIT, SLENDER TAIL

INTERESTED GOULD

GOULD GETS SURGERY & CHEMO -

AND TWENTY YEARS – D ‘02

A NATURALIST SPEAKS

“IT HAS BECOME, IN MY VIEW, A BIT TOO TRENDY TO REGARD

ACCEPTANCE OF DEATH AS SOMETHING TANTAMOUNT TO INTRINSIC

DUTY. OF COURSE I AGREE WITH THE PREACHER IN ECCLESIASTES

THAT THERE IS A TIME TO LIVE AND A TIME TO DIE, AND WHEN MY

SKEIN RUNS OUT I HOPE TO FACE THE END CALMLY AND IN MY OWN

WAY. FOR MOST SITUATIONS, THOUGH, I PREFER THE MARTIAL

VIEW THAT DEATH IS THE ULTIMATE ENEMY AND I FIND NOTHING

REPROACHABLE IN THOSE WHO ‘RAGE MIGHTILY AGAINST THE

DYING OF THE LIGHT.’”

STEPHEN JAY GOULD 1985




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SO WHAT IS IT WE REALLY WANT SIMPLY, NOTHING MORE THAN YOU WANT CHOICE AND CONTROL AT THE END! HENCE: ADVANCE DIRECTIVES EUREKA!!!




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AD’S & THE ULLYSES PACT

A FREELY MADE DECISION THAT

IS INTENDED TO BIND ONESELF

IN THE FUTURE

IN MEDICINE, WITH AD’s & LW’s,

THERE EXISTS CONTROVERSY

OVER WHETHER DECISIONS MADE

BY ONE IN ONE STATE OF HEALTH

CAN BIND ONE IN ANOTHER

WHEN AM “I” NOT “ME” ?




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COMPASSION & CHOICES

WHO WE ARE AND

WHY YOU SHOULD

GET TO KNOW US

ABOUT USCompassion & Choices is the oldest and largest nonprofit organization advocating for comprehensive end-of-life care and treatment options. Founded in 1980 as the Hemlock Society, and merged with Compassion in Dying in 2004, over the years the organization has grown, become more mainstream and now focuses on improving care and expanding choice at the end of life.




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A YOUNG ORGANIZATION – WITH TIMELESS CHALLANGES1980 – HEMLOCK SOCIETY

2003 – FOUNDER, DH, LEAVES

TO FORM “FINAL EXIT”

2004 – “COMPASSION & CHOICES”

Clients need not be members

Clients need not be“terminally ill”

Services may includereferral to other specialists, organizations, or officials

We never charge forservices

Eligibility for Services

DYING USED TO BE ACCOMPANIED BY A PRESCRIBED SET OF CUSTOMS

REAFFIRM ONE’S FAITH

REPENT ONE’S SINS

LET GO OF WORDLY AFFAIRS

LAST WORDS




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AND A COMFORT TO ALL -

A WORD ABOUT HOSPICE

BRITISH MD – DAME CICELY SAUNDERS 1940’S ST. CHRISTOPER’S – LONDON 1964 YALE SCHOOL OF NURSING THE CONNECTICUTT HOSPICE 1974

“WE DO NOT HAVE TO CURE TO HEAL”

US MD – ELISABETH KUBLER-ROSS “ON DEATH AND DYING” FIVE STAGES OF GRIEF

“IT HAS BROUGHT DEATH OUT OF THE DARKNESS”




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HOSPICE - A COMFORT TO ALL ?

MEDICARE COSTS FOR HOSPICE

HAVE INCREASED MORE THAN IN

ANY OTHER HEALTH CARE

SECTOR ‘05 TO ‘10 – 70% !!

IN 2010, 42% OF DEATHS

OCCURRED IN HOSPICES

(22% IN ICU’s)

MEDICARE PAYS FOR 84% OF ALL

HOSPICE PATIENTS -

(<6 MOS & ACCEPTANCE)




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“AMERICAN” HOSPICE PROBLEMS ON THE HORIZON ?HOSPICE NOW A $4.5 BILLION

PER YEAR INDUSTRY

40% OF HOSPICES ARE NOW

“FOR PROFIT”

AND COSTS ? 29% HIGHER/PT

AND NOW ? FRAUD ? LAWSUITS ?




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IS THERE ANY CHANCE

THAT WE CAN COME

TOGETHER AND ALL BE

OF ONE “MIND” - BE IT

AS ZEBRAS OR HORSES?




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CAN IT BE DONE ?

YES, IF WE RECOGNIZE THAT….

“EVERY GREAT ACHIEVEMENT IS A

BIRD ON THE WING.”




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JOHANN WOLFGANG von GOETHE

“AS LONG AS YOUARE NOT AWARE OFTHE CONTINUAL LAWOF DIE AND BE

AGAIN,YOU ARE MERELY AVAGUE GUEST ON ADARK EARTH.”




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HEMINGWAY - 1960

“THE WORST DEATHFOR ANYONE IS TO LOSETHE CENTER OF HIS BEING,THE THING HE REALLY IS”

IS THERE A TIME AND A PLACE HERE

TO SAY…………………

2011 - 22% OF DEATHS OCCURRED

IN AN ICU




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THE GRATEFUL DEADSTANDING IN A SHAFT OF LIGHT

RISING UP TO PARADISE,

I KNOW I’M GONNA SHINE

ACCEPTANCE OF DEATH WHEN IT ARRIVES IS ONE THING, BUT TO ALLOW IT TO UPSTAGE THE JOYS OF LIVING IS INGRATITUDE




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LIFE – A CIRCLE OR A LINE ?

“ I LIVE MY LIFE INWIDENING CIRCLES THATREACH OUT ACROSS THEWORLD. I WILL NOT COM-PLETE THIS LAST ONE,BUT I GIVE MYSELF TO IT”

RANIER MARIA RILKE

MORTALITY AND MORALITY HONOR CHOICE AT THE END OF LIFE




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SO THE QUESTION IS NOT

“WILL I DIE?”

BUT

“WHEN AND HOW?”

NO, LIFE & DEATH ARE NOT “THE FLAT TABLE”




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THERE ARE TWO KINDS OF LIGHT THOSE THAT GLOW AND ILLUMINATE

AND

THOSE THAT GLARE AND OBSCURE

“NOT A SHRED OF EVIDENCE EXISTS IN FAVOR OF THE ARGUMENT THAT LIFE IS SERIOUS, THOUGH IT IS OFTEN HARD AND EVEN TERRIBLE. SINCE EVERYTHING ENDS UP BADLY FOR US, IN THE INESCAPABLE CATASTROPHE OF DEATH, IT SEEMS OBVIOUS THAT THE FIRST RULE OF LIFE IS TO HAVE A GOOD TIME; AND THE SECOND RULE OF LIFE IS TO HURT AS FEW PEOPLE AS POSSIBLE IN THE COURSE OF DOING SO. THERE IS NO THIRD RULE.”

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MORTALITY, MORALITY & HONOR: THE END-OF-LIFE PARADIGM