Dennis Kane
Hospice vs Suicide Article
October 26, 2007

Hospice Care: A Viable Alternative to Assisted Suicide?

A terminally ill patient’s right to die promises to be a topic of controversy for some time to come. This includes physician-assisted suicide, a practice that has been implemented in a number of European countries and to a limited degree in one state in the US (Oregon).

The reasons most often given for those considering this option revolve around “dying with dignity,” and “becoming a burden to the family” or address concerns about suffering, or being kept alive by machines. Patients often state that if any of these events occur then they would like their lives to be terminated in a peaceful, painless and humane manor.

There is also another factor that may be influencing these thoughts: Depression. When a person receives a discouraging diagnosis or a terminal prognosis, the natural response is feeling out of control. And that almost invariably leads to depressions. Depression, in these instances, often subsequently leads to thoughts of suicide. In my experience with Hospice patients, depression usually resolves in a short period of time, with or without medication. However, like pain, depression is a symptom that can be treated and controlled successfully. Depression is not a good foundation from which to make end of life decisions.

It’s important to state that I have no strong beliefs, religious or otherwise, that suicide is wrong or bad. And I respect the considerations of people in a position to have to look at what life may be like after receiving a dire diagnosis. However, based on years of working as a Hospice nurse, I have come to believe that suicide is not the best choice for people with families who care about them.

This article addresses the concerns most often stated for choosing humane suicide, and suggests that Hospice Care is an alternative to this choice.

Dying with Dignity
Over my years as a Hospice nurse, I have observed that dignity comes from within and cannot be taken away by an unfortunate condition of life. One only need read stories of concentration camp survivors or prisoners of war to understand that the ability to maintain one’s dignity is inherent; it can only be given away and only when the sense of self is lost.

With Hospice Care, every attempt is made to maintain and support a patient’s sense of self and therefore their dignity. Patients are constantly reminded that they are who they always were, that it is only their bodies that are failing. Patients who have lived with dignity continue to do so through their illness, no matter what their symptoms do to their bodies. I have been inspired time after time by patients who have met the challenges of their illness with dignity.

Pain
Living in constant pain is a natural concern many patients experience. However, with the pain management techniques and medications available today, almost all pain can be controlled, if not eliminated. A person with a terminal illness can still have and maintain a life that has quality and enjoyment, and can spend quality time with their families and friends. Moving from a curative treatment to the palliative care of hospice often produces a dramatic improvement in quality of life that can be maintained right up to the last days.

Being a Burden
When patients express to me their concern about being a burden to their loved ones I remind them that whether they are a burden or not is not their decision. It is determined by their loved ones and that this is a choice that only their loved ones can make. Invariably, when I speak with the family members who are caring for the patient, they tell me that they would rather have their loved one present, even though they have to care for them. This is especially true when they know their loved one will not be suffering due to pain.

Life By Machine
Finally, there is concern about being kept alive by machines. In Hospice Care, we share this concern. As a group, we do not believe in keeping people alive by artificial means; we do not hook people up to machines. The philosophy of Hospice Care is to create an environment in the patient’s home—a familiar place— were they can die peacefully and naturally, surrounded by people who love them.

The Reality of Hospice
I understand that Hospice Care is not for everyone. I have seen patients who want to continue to “fight their illness,” to have treatments such as chemotherapy, radiation, and surgery long after they have been advised they can no longer benefit from them. I respect their decision and, at the same time, I regret the suffering I have seen as a result.

For those who accept that, short of a miracle (and I have seen those), their life is coming to an end, most likely within a few months, Hospice can be a positive choice. I have seen time and again that the end of life can be a unique opportunity for personal growth, a time for sharing and for coming to completion, for passing on family traditions and family lore. I suggest that this experience should not be denied, especially if the reasons for denying it are controllable.

Dennis Kane has been a hospice nurse since the late 1908’s. In addition to his private duty hospice practice, he consults with hospice patients and their families and is a frequent speaker on hospice to health care professionals. This article was adapted from his report, How to Work through the Stages of Grief, which is available at www.hospiceathome.com.