Part VI Some Hospice Care Providers Hasten Death Through Use Of Morphine Overdoses + Other Means?

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.

RELATED ARTICLES:

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
http://rffm.typepad.com/republicans_for_fair_medi/2008/08/part-vii-culture-of-death-taking-toll-on-those-nearing-lifes-end.html

"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
http://rffm.typepad.com/republicans_for_fair_medi/2008/08/living-wills-signing-your-own-death-warrant-a-christian-lawyers-perspective.html

 
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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Comments

[KansasGirl]

This country is losing it's moral compass. May God have mercy on our souls.

[sean]

I witnessed a hospice nurse give morphine to my wife's aunt (who was bedridden by a stroke). She died minutes after receiving the morphine. I honestly believe the nurse killed my wife's aunt. I thought about pushing for an autopsy, but don't want to burden my wife's family with the accusation.

[G]

my Dad just passed away while under Hospice care. I believe they killed him. After leaving the hospital to go into a nursing home because the hospital said he was not ready for hospice, he was very alert and strong to live. He'd whisper to me about others that were dying when in fact my siblings had planned an end to his ownlife. My Dad refused physical therepy and was then put into Hospice. Since I spent alot of time with him, and not the usual 45 minutes once a week as my siblings would do, i know that if he was tired from a poor night's sleep (up to urinate alot) then therepy and food intake would be affected, as would be with any of us. My brother and my sister were his proxy, and acting as his proxy before he was declared incapable of being his own. (he tried to contact his lawyer to be his own proxy, and in a meeting at the nursing he said he wanted to be his own proxy, but it was too late, they already decided to end his life.)Again, ignoring his wishes when in fact they were not legally his proxy at that time. I was constantly threatened by my siblings as i tried to help my Dad speak for himself-i.e. be at his own meeting, to which they had another meeting immediately after the one he was at in order to arrange his death. My Dad was an inconvenience to my siblings-their time share properties, their retirement days etc. and the money from his will would become less for them to have if he went on living with the nursing home costs. My Dad had COPD and was on oxygen, but no pain. He was in a wheelchair but wanted to keep using his legs to maneuver himself and he wanted to go to the bathroom himself, get himself into bed himself, dress himself etc. but was told they'd bring in the poice if he kept trying to do for himself. He became very intimadated, having to wait 20 minutes or more to go to the bathroom and would sometimes mess his pants while waiting andbe embarrassed. He'd tell me how he had to wait to go to bed, one night from 7:50 until 9:40 to get into bed. He was nervous that if my visits were long, they'd make him wait even longer for his needs to be met and like him even less than he felt they did. My Dad was taking 8pills or more, all at once, no throat closing up as they said it would, in order to justify the need for morphine. One Monday, i was going to take him to his favorite place to eat and told i could not take him although my siblings were not declared as yet his proxy--one week later, he is dead. I found, consistently, his oxygen would be on 0, or not hooked up after a nebalizer treatment, and he would then be without oxygen for hours before my discovery. i found the nebalizer cartridge-filled-on the floor near his bed. With these constant errors, i wonder what else was done to him. I was not allowed to see his medication, and then they were taken away and he was sedated to sleep,and morphine administered-when in fact he explicitedly said no morphine to them. I wish I had pursued an autopsy to verify he died from a morphine overdose-but being threatened to even my visiting him, makes a person not able to pursue what is right when wrong has been done.

[christina bowen]

I honestly believe with all my heart that if Hospice had not been in charge of my mother's care, that she would still be alive today. My mom was 70 years old and had cancer. We are well aware that this is a terminal disease, yet she was no where near the end of her life.

My mom had bone cancer in both of her upper legs. She was in a wheel chair so it was hard for her to travel. She was also on bottled oxygen. After several months of consideration she decided not to take anymore chemotherapy or radiation. The only thing she needed was something to control her pain, because the cancer was not going to go away. On September the first I took her to see her oncologist for the last time. They decided together that Hospice could provide her with the care she needed from here on out. On that day my mom was of sound mind and doing well. We left the doctor's office and went out to dinner together.

The next day the Hospice nurses came to the house for an evaluation. They took control over all of mom's medications and instructed us not to call 911 in case of emergency. Everything from here on out was to be determined by the Hospice physician. They immediately increased her fentynol patch from 50mcg-100mcg. They increased her oral pain medicine from 30mg oxycodone to 100-120mg oxycodone per day.

The changes started immediately. At first she seemed to be "high". She was sleepier than normal, kind of nodding out all the time. Started being confused, loss of appetite, and had trouble swallowing. We called the Hospice nurses and reported the side effects. My sister and I was convinced that she was receiving too much pain medicine and that she might even overdose from it. They insisted that it was just a part of the final stages of life. Even though no one ever came to the house to check her out.

As time went by the side effects worsened. She started having trouble breathing, sweating, and even hallucinations. She finally went into a coma. We were on the phone with Hospice constantly trying to seek help for our mom. We knew that she was being overdosed but again was told that it was a normal part of the death cycle.

On Sept. the 8th Hospice finally showed up at the house. Mom was in a coma and unable to take her medicines. They insisted that she was just in her final stages of life and the morphine had nothing to do with what we were seeing.They said she must continue to take her morphine, so they went to the pharmacy and ordered a liquid form to be administered. She died later that evening.

I know cancer kills people. I know that my mom was going to eventually lose her battle and die, too. But I also know that she was not there yet. She was just in pain, she wasn't dying. So in a time span of 5-6 days, our mom went from being an independent, strong willed woman, to a child like infant, and then finally just gone.

I blame myself for allowing this to happen. Looking back I know I could have done something to have prevented this. I should have followed my instincts and removed the patch, stopped the oral drugs, and took her to the hospital against their instructions. But I didn't. I let them kill my mom.
So, for anyone reading this, I beg you to please, please, think long and hard about signing a loved one up for Hospice. And make sure that you are ready to say goodbye when you do.

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Dear Christina,

We are so sorry to hear of your Mother's death. You have our deepest condolences. However, do not blame yourself for what happened.

I want to tell you something amazing. When my wife first saw your comment to our blog, I was in the middle of writing a column exactly about this subject. I was taking a break and my wife found your comment waiting to be posted. In addition to posting your words as a comment on our blog (RFFM.org) I am going to include your poignant words in a column I am writing for the Illinois Family Institute's web site (www.illinoisfamily.org) at this very moment. I posted a letter from someone else who believes their Father was also killed by Hospice care. Here is the link to this person's sad and similar story: http://rffm.typepad.com/republicans_for_fair_medi/2010/08/some-hospice-care-providers-enforcing-state-sanctioned-euthanasia-through-probate-courts.html

I believe God is at work here. Please believe your Mom's death will not be in vain. Hospice care providers are putting people to death who do not have a terminal diagnosis. I know your Mom had cancer, but some hospice providers are killing people who do not have immediate terminal diseases, like Alzheimer's. This is part of the culture of death which has permeated our society. Thank you so much for sharing your story. I know it had to be very hard for you to write this, since your Mother just passed recently. We will keep you in our prayers.

God bless,

Dan & Julie Zanoza
RFFM.org

[Pat]

My mother died on October 14, 2008 at 73 years old. She had Parkinson's Disease and was a breast cancer survivor. My brother had put her in a nursing home 2 years after my dad died. I am the only daughter but lived 14 hours away. My mother and I were always close and talked almost every day. She began to complain with her fingers hurting and turning dark at the end of July; she loved art and was doing some form of paint or colors all the time. Mid August, she was diagnosed with Gangrene in those fingers. She was in and out of the hospital until the end of September when she was sent back to the nursing home under Hospice care. When I arrived, she was only able to communicate with the blinking of her eyes. Her fingers looked like charcoal. They had taken all meds from her. She was rigid and unable to move. I gave her a drink of water and she acted as though she had not had a drink in days. Two days later, I asked her if she was hungry and she blinked for 'yes'. She ate 10 to 12 bites and drank water. The nurse came in and I shared what I thought was good news. She (the nurse) was very agitated and told me my mother was to have "NOTHING by mouth." The last dose of morphine the RN gave her was much larger than previous ones. I knew it would kill her. The RN never had eye contact with me that day; she knew it would kill her as well... We had talked many times by phone about Mother's condition. She had listened to me cry with every call. She knew how much I loved my mother. During that time, I was hurting so much and trying so hard to be strong for Mother, I failed to see the facts. Once I got home again, it hit me like a brick. They killed her. I had begged her to not go to the nursing home, but to come and live with me and my family. She would not because that was her home and my dad was buried there. I will forever feel guilty for not MAKING her come home with me. I am thankful for the many times I was able to go and spend weeks and months at a time with her. But I will regret the time I spent watching a group of people kill her with morphine...