Academic journal article The Hastings Center Report

Conflicts of Conscience: Hospice and Assisted Suicide

Academic journal article The Hastings Center Report

Conflicts of Conscience: Hospice and Assisted Suicide

Article excerpt

John F. worked as a hard rock miner during his early adulthood, and then as a postal carrier until retirement. Even in old age, he remained a strong 6'4", 225-pound man who enjoyed deep-sea fishing.

Two days after his seventy-ninth birthday, John was diagnosed with glioblastoma and offered a poor prognosis. He was recommended for hospice care, and upon admission, complained to a nurse, "After I die, everyone's going to drink my best liquor." Shortly thereafter, John gave a Party for 200 relatives and friends, helping them finish off all the liquor he had saved over many years. The following week he a took a Fourth of July weekend trip to the ocean with his wife and children. On 5 July, however, he became completely paralyzed on one side and return home to bed.

John's life willingly became his primary caretaker for the first few weeks. His sister, who had spent many years caring for her quadriplegic son, soon arrived to help John's wife with his personal care. Shortly afterwards, John became incontinent of urine and stool A male hospice nurse was assigned to John in an attempt to accommodate his self-describe "extreme modesty." The nurse placed a Foley catheter, but this was extraordinarily painful Although the hospice team tried many remedies, including antispasmodic medications, nothing relieved the discomfort of the catheter. Over a weekend, the on-call nurse, a woman, decided to replace the Foley with a condom catheter in an effort to reduce John's pain. Placement of the condom catheter required a lot of "fiddling" in order to secure it adequately, an experience that was enormously humiliating for John.

Once the condom catheter was in place, John's pain remained in good control He received meticulous care from everyone. The family situation was loving and goodbyes were said.

As John became sicker, he continued to suffer profound and unrelenting embarrassment over his physical care, particularly bathing and toileting. Several times he said to his nurse, "I wish you could kill me. I don't want to go through the rest of this illness." The family told the nurse they supported his wish. The nurse responded, "I wish I could, but I can't." Within several days of his request for assisted death, John became comatose, and five days later he died. His ashes were tossed into the ocean from a fishing boat in the presence of forty of his friends.

Hospice staff frequently care for dying patients who suffer unmanageable physical pain that renders continued life unbearable or who wish to escape the physical and psychological torment imposed by an illness that is not imminently life-threatening. The hospice community has characteristically responded with "we can't" to patients who request assistance in dying, and instead has offered palliative care and human presence to aid patient control. However, the November 1994 approval by Oregon voters of Measure 16, the "Death with Dignity Act," which permits terminally in patients to request that a physician prescribe lethal drugs to end their life, poses new challenges for hospice's identity and integrity. In particular, hospice staff in Oregon, and undoubtedly elsewhere, will now confront dilemmas of how to respect and honor patient autonomy while remaining faithful to the hospice mission of providing care that neither hastens death nor prolongs life. This essay seeks to initiate ethical inquiry in some uncharted terrain for hospice and for society. We begin with a brief historical discussion of the moral boundaries of the hospice philosophy.

Historical Perspective

The standard way of posing the question of legalized physician-assisted suicide, namely as a conflict between personal autonomy and state paternalism, is not the moral terrain that confronts hospice. Unlike the liberal state, which is supposed to adopt a stance of neutrality in matters pertaining to the good life or death, the hospice movement embodies a moral tradition of fundamental convictions about what it means to the well. …

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