Do Some Hospice Care Providers Hasten Death Through Use Of Morphine Overdoses + Other Means?
by Bill Beckman, Executive Director, Illinois Right to Life Committee
Editor's Note: This is the sixth in a series of columns first posted on the Illinois Right to Life Committee's (IRLC) website [http://www.illinoisrighttolife.org/] written by Bill Beckman, IRLC's executive director. The column discusses hospice care. Beckman relates nightmarish, firsthand recollections regarding patients and their hospice providers. This series warns readers about end of life issues and the need to monitor the care given to loved ones. The IRLC director also describes what readers can do to protect themselves from the looming culture of death which permeates the thinking of many medical facilities in our nation. Below are links to all parts in this series, plus two columns written in 2010.
The following was written by Bill Beckman *
Hospice has developed a good reputation for providing compassionate care for dying patients. A key principle of this care is: hospice neither artificially prolongs life nor hastens death.
Unfortunately, this principle is no longer consistently followed in hospice care (as discussed in the previous article in this series). This lack of consistency requires a “buyer beware” attitude when evaluating which hospice might be appropriate to provide truly compassionate end-of-life care.
Now that we have established that at least some hospices deviate from the original mission of hospice, some real life examples will clarify how hospices can act to hasten death, while justifying such actions as compassionate and caring. These examples show how hospice care can fail to "improve the quality of a patient's last days by offering comfort and dignity." Suggestions on the means to evaluate whether a hospice will truly care for, or likely kill, a patient are also provided below.
A man named "Bruce" called me on September 29, 2005. He heard the IRLC message about the Patient Self-Protection Document (http://www.illinoisrighttolife.org/pspdoc.htm) on WIND radio 560 AM. Bruce called because he thought he should obtain a copy for his mother. The background that led Bruce to that conclusion is most disturbing. He witnessed his father being killed by a hospice nurse who used an overdose of morphine. The nurse who came to his father’s house to provide hospice care actually tried to get Bruce’s mother to give the morphine to her husband, but she refused. So the nurse administered the overdose of morphine herself. Bruce said his father was not in pain. Pain would have been justification for giving some morphine to Bruce's father, but there was no medical justification for any morphine to be administered in this circumstance.
That experience proved to be more than enough for Bruce to have his mother complete a Patient Self-Protection Document. But there is even more that concerns Bruce. It turns out Bruce’s sister is a hospice nurse. Bruce's sister actually thinks she is doing the compassionate thing when she overdoses hospice patients by using morphine.
She even told her mother about providing morphine to the children of a 93-year-old man so they could relieve his suffering whenever that might become necessary. This man happens to be a friend of Bruce’s mother, he still drives and gets along just fine. How might Bruce's mother let her 93 year old friend know that his own children are armed with morphine and could be dangerous to his health--if he develops medical problems?
Bruce’s mother told her daughter she should leave her job as a hospice nurse “because she is killing people.” How does she face the knowledge her daughter is ready to end her life--if she becomes too much of a burden? This lady is legally blind and deaf, but is still able to take care of most of her needs. Her daughter suggested she consider hospice, and she replied that a nursing home would do just fine. This nurse works at a hospice facility near Elgin, Illinois area. I could say, if you are considering any hospice in that area, beware of this situation, but, in actuality, you should take great care in choosing an hospice facility, no matter where it is located.
Bruce made an observation based on his experience with his sister. He said she never came home at breaks during college, but if someone had an ailing animal to be put to sleep, she would come right home to take care of it. Now, she apparently thinks human beings should get the same treatment. Bruce thinks she is quite happy with her job, even though she is dealing with death, and people near death, all the time. He observed that hospice work could easily attract people who think like his sister.
I have received additional calls from people who have witnessed similar occurrences with other hospices. Fortunately, in one case the result was better, as expressed in an e-mail I received from a lady I will call Angie. When Angie's husband needed hospice care, she was already knowledgeable about morphine dosages because her husband had needed it for pain control for two years. When hospice got involved nine days before her husband died, Angie was given a schedule for morphine every 2-4 hours, but Angie only gave her husband morphine once per day until the last two days when she gave two and then three doses, but never anything even approaching 6-12 doses per day. Angie wrote, “He was never uncomfortable, was coherent to his last breath, and telling his family he loved God and wanted to be with Jesus.” Her family never allowed him to be left alone with a hospice nurse. Other families are not as fortunate. In many cases, the family members are innocently giving the morphine doses per the hospice schedule that hastens death without even realizing what is happening--until it is too late, or never knowing the truth.
Unfortunately, some relatives do not exercise the wisdom and love Angie used while taking care of her ailing husband. In another case, a wife made a decision to get hospice involved in her husband’s care during his recovery from both surgery and another medical procedure to remove a brain tumor. Even though the brain tumor was declared to be in total remission by the surgeon and the patient was not in pain, pain medications were forced on the patient. This was the initial stage of the process that, too often, leads to an eventual overdose on morphine. I was asked for advice by the patient’s niece who witnessed the mistreatment of her uncle. The niece was eventually denied access to her uncle because she was trying to help him--rather than trying to hasten his death.
In another case, a mother was on a feeding tube and being cared for at home by one of the younger sons among her eight children. The oldest daughter, who was the designated agent on her mother's Durable Power of Attorney for Health Care, arrived one day to take their mother to hospice “because she would not want to live this way.” Most of the siblings, who opposed this move to hospice, needed to get an attorney involved even to get the opportunity to learn where their mother was taken so they could visit her. They learned their mother was no longer being given food through her feeding tube. And even though she had not been taking pain medication at home, she was now being given morphine under hospice care. Tragically, she died within a week.
Might one conclude that morphine overdoses are being used by every hospice? No. I have talked to a number of people who have friends or relatives who have recently been under hospice care and have continued to live for a number of months. Those hospices did not use these procedures to hasten death (because when hospices do use these practices, patients are often dead in three to five days after entering hospice care).
Some hospices have a policy that no patient can remain on a feeding tube upon entering hospice care. Such a policy is a clear sign the hospice is willing to hasten death. If a feeding tube is effectively doing the job of providing the patient with food and water, then removing it will result in a hastened death from starvation and/or dehydration. Such action will certainly not "improve the quality of a patient's last days." Rather, it is an immoral attack on human life. Of course, if there are medical indications that the patient's body can no longer process the nutrients provided through the feeding tube, then removal is justified, but such individual cases cannot justify a blanket policy to end tube feeding upon entering hospice care.
How many hospices hasten death versus how many do not? It's very difficult to know, but hospice leadership organizations, including the Hospice Foundation of America, National Hospice and Palliative Care Organization and, most likely, a significant number of others are pushing hospices in that direction. The efforts of these organizations indicate even if a certain hospice was faithful to the original mission of hospice in the past, policies could change. Therefore, understanding current hospice policies is always crucial when choosing that hospice for a new patient. Whether death is hastened by denial of food and water or suppression of breathing using overdoses of morphine, this is certainly not death with dignity!
Illinois Right to Life offers a Hospice Checklist (http://www.illinoisrighttolife.org/HospiceChecklist.htm) to help evaluate the underlying philosophy of care practiced by any specific hospice. Seeking answers to the questions on this checklist should be helpful in that evaluation.
The tragic situations described above--where the patients' relatives actually wanted hospice care to hasten death--reinforce the need to be very cautious in what type of advance directive you complete and who you designate as your agent to make health care decisions for you, if you cannot make them yourself. Even using a life-affirming Durable Power of Attorney for Health Care, such as IRLC's Patient Self-Protection Document (http://www.illinoisrighttolife.org/pspdoc.htm), will be no match, if your designated agent does not respect your life and has access to hospice care that has no problem with taking steps that hasten death. To protect your life, you need to identify both relatives and health care professionals who respect life and reject the "Right to Die" movement's philosophy that ending life prematurely is "compassionate" and "dignified" when the patient is deemed to have a "low quality of life."
* Contact Illinois Right to Life Committee: (312) 422-9300
IRLC website: http://www.illinoisrighttolife.org/
The above column was first posted on RFFM.org in September of 2006.
The following series of columns are related to end of life issues and written by:
Bill Beckman, Executive Director, Illinois Right to Life Committee http://www.illinoisrighttolife.org
Stephen Bloom, a Christian Attorney at Law, an expert on living wills and author of "The Believer’s Guide to Legal Issues" http://www.istherealawyerinthechurch.com/ and
Daniel Zanoza, Executive Director, RFFM.org
Part I The Myth Of Living Wills: You Are Actually Signing Your Life Away by Bill Beckman posted August 11, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/the-myth-of-living-wills.html
Part II How a Living Will can bring about your premature death by Bill Beckman posted on August 12, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/how-a-living-will-can-bring-about-your-premature-death.html
Part III Futile Care--Knowing What It Is May Save Your Life Or The Life Of A Loved One by Bill Beckman posted August 13, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/part-iii-futile-care--knowing-what-it-is-may-save-your-life-or-the-life-of-a-loved-one.html
Part IV Research on "brain dead" and "almost dead" patients declared "ethical" by Bill Beckman posted August 14, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/part-iv-research-on-brain-dead-and-almost-dead-patients-declared-ethical.html
Part V Choose Hospice Care Provider Carefully: Using Hospice Care To Hasten Death Declared "Ethical" by Bill Beckman posted August 15, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/part-v-choose-hospice-care-provider-carefully-using-hospice-care-to-hasten-death-declared-ethical.html
Part VI Some Hospice Care Providers Hasten Death Through Use Of Morphine Overdoses + Other Means? by Bill Beckman posted on August 16, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/part-vi-some-hospice-care-providers-hasten-death.html
Part VII Culture Of Death Taking Toll On Those Nearing Life's End: Overview -- by Daniel T. Zanoza posted on August 17, 2008 at
"Living Will" Becomes a License to Kill: The Horror Goes On In 2008 by Bill Beckman posted on August 18, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/living-will-becomes-a-license-to-kill.html
Living Wills: Signing Your Own Death Warrant? A Christian Lawyer’s Perspective by Stephen Bloom posted on August 19, 2008 at
Some Hospice Care Providers Enforcing State-Sanctioned Euthanasia Through Illinois Probate Courts posted on August 13, 2010: http://rffm.typepad.com/republicans_for_fair_medi/2010/08/some-hospice-care-providers-enforcing-state-sanctioned-euthanasia-through-probate-courts.html
Hospice, Living Wills, Futile Care: Hospice, Hospitals & Nursing Homes Have License To Kill by Daniel T. Zanoza posted on October 5, 2010 on the Illinois Family Institute's website: http://www.illinoisfamily.org/news/contentview.asp?c=35036
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