Palliative care must be more accessible
Commentary: Making the case against euthanasia
The New York State Legislature should promote skilled end-of-life care rather than focusing on ending life prematurely.
The International Association of Hospice and Palliative Care recently published (Journal of Palliative Medicine 2017; 20:8-13) a studied position statement (Journal of Palliative Medicine 2017; 20:8-13). In it they conclude: “No country or state should consider the legalization of euthanasia or Physician Assisted Suicide until it ensures universal access to palliative care services and to appropriate medications.”
Our National Hospice and Palliative Care Organization concurs (National Hospice and Palliative Care Organization, Statement on Legally Accelerated Death, Nov. 4, 2018).
The field of hospice has come a long way by using inter-disciplinary teams to address what is called “Total Pain” and treat the whole person. Total pain is a concept introduced by Dr. Cicely Saunders, the founder of the modern hospice movement. A person’s total pain includes not only physical and emotional suffering, but also relational and spiritual/existential pain. I have seen death accurately described as “good” and even “beautiful.” This occurs when total pain is addressed; it occurs when reconciliation, forgiveness, gratitude, and transcendence are part of the patient/family experience. However, when assisted suicide is an option, patients and their families are denied that experience in exchange for a pile of lethal pills.
Palliative medicine has recently blossomed with a growing experience, skillset, and literature base. No longer do patients need to dread the uncontrolled pain in dying that some have seen with their relatives.
In states where it is legal, physical pain is not the primary reason Americans request assisted suicide. According to data from Oregon, what people fear is loss of meaning or control. It is existential pain. Here is where the skills of hospice chaplains and social workers/counselors become so critical. In addition, new pharmacologic options Journal of Palliative Medicine, Taking Psychedelics Seriously, 2018;21:417-421) are coming into play to target existential pain.
Sadly, despite the increased options available to help ease suffering and treat total pain, New York residents are not benefitting from improved care. New Yorkers with a prognosis of six months or less to live dramatically underutilize hospice services, with New York ranking 47th in the nation when it comes to hospice utilization. Nationally over 48% of Medicare patients choose hospice care. In New York, only 30% do so (2017 Medicare Information in 2019 NY State Hospice Report from HPCANYS). Shouldn’t we focus our efforts on promoting quality care, not death, in life’s final moments?
Meanwhile most New Yorkers do not even have access to palliative care. Palliative care is the related program which extends the hospice team expertise to seriously ill persons who have more than six months to live or to patients who continue to take active cancer treatment. California has mandated that all insurance companies pay for palliative care.
In our area, Medicare recipients have been able to access palliative care through New York’s Medicare Delivery System Reform Program. This is ending on March 31 in Western New York. Only a few sites in New York even did this program and renewal is looking dubious.
The field of hospice can care for the whole person as they approach death and accompany them in their time of vulnerability. Assisted suicide cannot. New York legislators should reject assisted suicide and prioritize making excellent end-of-life care available to everyone in the state.
Dr. Tom Putnam is the medical director for Chautauqua Hospice and Palliative Care in Chautauqua County. He is the only physician in this county who is board certified in Hospice and Palliative Medicine.