president obamas definition of end of

Tuesday, August 11, 2009



President Obama’s definition of “end of life care”

I have tried to remain silent on the blog about the health care debate in our country. I have very strong political opinions and do not feel that this blog is the place to have political debate. This is a blog about hospice, and the last thing I want to do is turn people away from hospice because they disagree with me politically. I don’t think what I’m about to say is really a political statement, but I felt I needed to put that disclaimer up front just in case. Now.


I really wish President Obama would stop using the term “end of life care” when talking about medical care for the elderly! I’m thrilled that our president is a fan of hospice care, but I want to make sure that everyone knows that what is being discussed in the news today is not hospice care. They are talking about how we would provide medical care to the elderly, how it would be distributed, and most importantly how it will be rationed. Those subjects have nothing to do with hospice, but I fear that hospice is about to be drug into this debate in a way that will not be good for the hospice movement.

I’d guess that most of you have seen the video of President Obama talking about whether a 100 year old woman will be allowed to get a pacemaker in his new health care system. If not, here it is.



There’s that term – “end of life care”. Not long after he uses the term, he says that the government may have to let doctors and patients know that the treatment they are considering isn’t going to help and instead of the treatment they should just take a pain pill. This is where I get really scared. To me, end of life care, is hospice care. Those two terms are synonymous. I also think that when people think about pain pills and the end of life, they think hospice. Everything about what he said makes me cringe in fear that the next words out of his mouth will be, “we’ll put her on a great hospice program”. While that would be great for business, there is a major difference between what the president is talking about and what I want to do for a living. A huge part of being a hospice patient is the ability to choose to be a hospice patient. It’s not a death sentence handed down! Hospice is a choice to pursue treatment that will ensure your comfort and quality of life.

I talk to people all the time who are making what I believe to be a stupid medical decision. I vividly remember a patient we had recently. I went to the hospital to do a hospice consult with he and his family. We talked. He cried quite a bit. He was scared of dying in pain, and we talked about that. He asked me to pray that God would take him that night while he was sleeping. I did. He told me that the doctor had told him that he could do a procedure to remove a “bunch of sludge” between his heart and lungs and that, if he survived the procedure, he would be able to breath much better. (He would still be very much hospice appropriate, but breathing better.) The doctor had also advised him against the procedure and told him that he thought there were good chances he would die on the table. He was thinking about his options, and would let me know. He had the surgery, survived it, and when home on hospice after a couple of weeks recovery in the hospital. When I went to the house he told me that he figured the only two possible outcomes from the surgery were less pain and misery or going to heaven after dying painlessly on the operating table, so he chose the surgery. Making that choice boggles my mind, but I love the fact that he got to make the choice. He got to decide what was best for him, and that is, to me, the core of what hospice is all about.

Mr. President, I’m begging you, we can debate health care until we are all blue in the face, but let’s not act like “take a pill” end of life care that you qualify for because of your age or your lack of usefulness to society is the same thing as what hospices across our country are doing today. To make that implication is nothing short of insulting to me and the thousands of hospice workers across our nation who believe to our core that each and every person has the right to choose how and where they want to live out their final months.

19 comments:

Jessica Knapp
said…

Heck yeah! Thank you for your post. As a former proofreader, I am all for using the correct terminology. It's so great that issues like these are getting discussed in a high-profile way—although I really wish the discussion wasn't so vitriolic—but you're absolutely correct: Let's use the terminology correctly.

TheMomma
said…

Thank you.
Speak the truth.
This debate is causing a lot of fear in the people in our community (rural).

Designs for Health
said…

End of lifecare sounds very rude and mean…The president must rethink the words again.


J T Partee
said…

My wife works in hospice and I absolutely agree that it's horrible how the current political debate is making hospice sound like a death sentence.

I would urge you to replace your current video with the original 3:56 clip in which Obama's actual response to the 105-year old mother is included, it is more clear that he's not talking about that example when he brings up the choice between an ineffective treatment and a painkiller, and he repeats several more times that he wants patients and doctors making these decisions. His use of "end of life care" is needlessly scary, but it's good to know that his first response was personal – "I want to meet her."

karen
said…

My mom is not end of life but Hopice is coming to care for her. If not for them we would be broke. I had to stop working the care for her 24/7 . She cannot get medicad,food stamps, elder choices ,etc. because she has to many resources . But we still hardly had enough money to buy food after bills, meds. and all the stuff to care for her needs. she does not walk and wears diapers. There is lots of needs. Anyway . It cost more to pay for care than I made or she could pay. So I stopped working. cashed in IRA, teacher retirement and used all my savings. Than came hospice .They pay for everything she needs. and Care for her greatly. I realize they don't pay for blood pressure meds. or alziemiers meds. but they pay for all her other meds.Which is alot. I can pay for those two if I want or not my choice. l love hospice. They saved us.
http://alzheimersandmomblog.blogspot.com/


Daniel Hospice NP
said…

Actually, I think he's quite accurate in how he uses the term. It's entirely appropriate to think of care for the very old, and care for those in declining health, as part of a continuum of end of life care, with hospice at the very end of that arc. Too often old people with significant QOL impairment receive full-on aggressive intervention, the only alternative to which is hospice care. Using end-of-life in a context broader than hospice suggests that the diminishing returns of aggressive intervention are recognized even when death is not imminent.


Cheryl B-N
said…

I don't think of end-of-life as being synonymous with hospice, anymore than I think palliative care is synonymous with hospice. "End-of-life care" might not be the best term to use, but the way I use it (and the way I teach continuing education classes on this topic here in FL) is that when we are in the time of life that we have less in front than behind us, the issues we face are complex and numerous. There are financial, social, spiritual, emotional, and medical considerations to work through.

We should have choice in our medical care, but I'm wondering how much choice can be reasonably paid for by others. What one person would call rationing another would call not paying for futile care. At what point do we change the idea of "we can, but do we want to?", to "we can, but we won't". Thorny questions, to be sure, but I've also seen many elderly, incompetent or aphasic patients revoked for aggressive treatment by concerned (and often guilt ridden family members who haven't been involved in the care until the bitter end) only for the patient to die a few days later on a vent/post surgery/etc. When should medical professionals say "no" to these clearly futile proceedures? Yet many physicians will claim that even the smallest chance should be taken.

Families are offered procedures we all know won't work, will be painful for the patient, and are expensive, yet they're offered and the family often times feels obligated. After all, they can then say "at least we did everything we could" when the patient dies.

So, yes I do think that "end-of-life care" is broader than hospice, that hospice is one part, one choice, in this broader concept to consider and make choices within.


Anonymous
said…

Pretty interesting place you've got here. Thanx for it. I like such topics and anything that is connected to this matter. I would like to read a bit more on that blog soon.

Chiropractic St Paul mn
said…

Its excellent perfect saying, End of Life Care, video is show nice ideas good Thank You

Hospice CA
said…

Hi, I have been reading this blog fully understand the idea of the Me.Obama's,let you know that I am a fan and enjoy your work.Thanks for this super blog.


Anonymous
said…

You need to quit listening to FOX news and research the truth about health care reform for yourself.

Jose
said…

Great blog. Also, great post.

Healthcare Market Resources
said…

Thank you for this post. Hospice care is so much more than just taking a pain pill, and you have articulated this point so well.

Hospice Care Tampa
said…

I listened to the video several times.I don't think he was talking about hospice. The lady whose mother needed a pacemaker, wasn't diagnosed as dying, just needed a pacemaker. It sounded more like he was talking about advance care directives to me. My father-in-law did not have one and one week before he died, the doctors implanted a defibrilor and pacemaker -for what? That's what Obama was talking about when he used the word,"waste."

Frank Gray
said…

Everyone deserves the right to hospice care. In the end, this all come down to money. Fortunately for Seniors over the age of 65, there are solutions for circumventing the government from a financial standpoint. Life Settlements are just one way to help Seniors in need pay for hospice care.


Anonymous
said…

I'm so against the Obama healthcare, our elderly deserve as much medical help as anyone else. My grandmother was in hospice a few years ago, she lived at home with us, but hospice made things so much easier. Knowing that someone was just a phone call away made the hard days so much easier for me and my family. I found a book on the "end of life journey" called Peaceful Passage. The book talks about hospice care and how great it works with home care. I would be very sad to see hospice go away.


Anonymous
said…

You're right this Hospic Blog on politics is not a place for your opinion about the President, for we are all aware of what's going on in Washington. I loged on in hope of finding knowledge and support for self and family member but since this was the wrong day to log on because your thoughts were other places then the emotional support for family

Jasper County Hospice
said…

Well, everyone of us had a different insight with hospice, some agree and some don't. In my own opinion, hospice is a place where ill people find comfort and care that they need.

Hospice Care in Columbus Georgia
said…

I just browsed across this post. I run a hospice care facility in Columbus Georgia. I am glad that our industry, hospice care, is being discussed in the political arena.