I was talking with a Rabbi this evening about hospice and Jewish law. There are a couple of misperceptions which he shared that I thought were in need of clarification for people.
1. Hospices get paid per patient and thus have no incentive to keep people on service for a long time:
From a financial standpoint, hospice is government funded through Medicare and Medicaid. The way the funding works is that hospice is paid per patient, per day of care for the patient. Therefore, it would behoove hospices to have patients on service for longer periods than just for a couple of days. Being that it makes fiscal sense, it is sad to think that hospices do often act as if the goal is to provide a quick transition to death. I think hospices need to rethink their approach in presenting to people what care is being given and its benefits. People are still scared because they hear about how hospices stop all medications, etc. Of course, hospices do stop medications that are counter to comfort care or have no effect on the person’s well being at this point. In addition, many of the medications discontinued are only being taken because too many doctors prescribed too many things. I have often witnessed how stopping the over consumption of medication can prolong a person’s life.
2. Morphine is a problem because it shortens a person’s life:
Morphine is administered by hospices as one of many pain medication options. Morphine’s primary function is to relax labored breathing. Hospices are hopefully cautious in their use of morphine. Additionally, rarely is a lethal dose given, especially if the hospice is managed by competent medical personnel. Having said that, morphine has an unintended effect due to its ability to calm breathing, namely that a person might die “sooner.” Since that is the case, people make the observational conclusion that morphine kills, leading to the fear of morphine use and the anger of hearing the hospice suggest such a measure. From a halachic perspective, this is challenging, for while hastening death is considered murder, being that the quicker death was unintentional, it would be permissible to administer morphine.