Monday, April 27, 2015

"Pro-Life" Hospice Care?

"Pro-Life" Hospice Care?

Dr. Brian Kopp

There was a time, not long ago, when the idea of designating a hospice care program as "pro-life" would have seemed absurd. Most hospice care programs in the US in the 1970s and 1980s sprang from roots in Christian ministry to the sick and dying, and the sanctity of human life was always paramount in these grassroots hospices. To understand why things have changed, we need to understand the Christian roots of hospice care philosophy and how the hospice industry has deviated from those origins.

In the Middle Ages, many Christians made pilgrimages to the Holy Land. They frequently became sick on the long and arduous journey. Pilgrims who were unable to complete the journey home were admitted to the care of the Knights Hospitaller in their hospice in Jerusalem. Christian care was provided to fulfill the Corporal and Spiritual Works of Mercy, and hospices were subsequently  founded along pilgrimage routes in other regions. In France, the Daughters of Charity of St. Vincent de Paul opened hospices in the 17th century, and the Irish Religious Sisters of Charity opened a hospice in Dublin in the late 19th century. Churches led the way in the care of the dying well into the 20th century, which saw the emergence of two great leaders in the hospice field.

Most know of Mother Teresa and her pioneering work among the dying in India's poorest regions, her establishment of the first hospices for AIDS victims in the 1980s, and her uncompromising pro-life stance. England's Dame Cicely Saunders began her career in nursing, transitioned to social work and eventually completed medical school in order to help the development of modern hospice care. She also developed a lively faith as a result of joining a Christian study group founded by C.S. Lewis at Oxford University. She took a keen interest in the needs of the dying, recognizing that their physical, mental, emotional, and spiritual needs and sufferings were simply not being met in the medical system of the first half of the twentieth century. Dame Saunders was fully committed to the sanctity of human life and strongly opposed euthanasia and assisted suicide.

The early grassroots hospice programs that started in the late 1970s in the USA took as their foundation the Christian philosophy of the sanctity of life held so dear by Mother Teresa and Cicely Saunders. Most hospice work was volunteer-based and primarily provided as Christian works of mercy. Unfortunately, the federal government's introduction of a Medicare hospice benefit in 1986, while providing stability and a revenue steam for these hospice pioneers, also introduced the profit motive.

Within two decades, big for-profit corporate hospice providers had completely displaced these grassroots non-profit community based hospices in many markets. Today, all of the large for-profit corporate hospice providers have been credibly accused of massive amounts of fraudulent hospice billing; the largest for-profit corporate hospice provider stands accused of a billion dollars per year in fraudulent insurance billing for the last ten years.

Most of this fraud consists of admitting patients to hospice who aren't actually terminal, thus billing for inappropriate care, or billing for higher levels of care than patients actually need. Fraud by neglect and by withdrawal of routine chronic medications is common. Also, omissions (e.g., inappropriate withdrawal of food and water) or commissions (e.g., over-medication) frequently lead to premature deaths. We call these deaths "stealth euthanasia" whether they are deliberate or not.

Sometimes these deaths occur simply because of greed. For instance, hospices commit fraud by not providing services and supplies to which patients are entitled, by denying patients medications for chronic conditions such as heart disease or diabetes, or by over-medicating patients to make them appear sicker than they are in order to bill more for higher levels of care. Sometimes, as in the case of Terri Schindler Schiavo's death at the hospice in Florida, deaths are caused deliberately. The pro-life movement needs to recognize, understand, and fight against "stealth euthanasia."

It is also imperative that the pro-life movement help develop and support "Pro-Life Hospice Care."