Most psychologists are aware of the availability of hospice care for patients who have an incurable medical condition and a limited prognosis. These programs have served patient/family needs for several decades and some psychologists have provided very important services in this context. One situation that has always been difficult is when a dying patient could significantly benefit from hospice-types of care and services, but did not meet the criteria for acceptance into the hospice program. The field of care called Palliative Medicine has emerged to care for patients who have chronic conditions and who need help and support in managing these conditions, but who are not appropriate for hospice care. In fact, the National Hospice Organization changed its name to the National Hospice and Palliative Care Organization to recognize this need and the importance of providing care to a broader range of patients and families.
We know that many patients and families avoid hospice care, because they feel it means “giving up.” Since hospice care typically requires that the patient is not receiving “aggressive” or “curative” care it is easy to see why people would think this, and this is one of the reasons why many referrals to hospice occur too late for the program to help as much as it might. Further, many physicians are reluctant to stop aggressive treatments too soon, and may prolong treatment with hope of making some difference, but delaying a meaningful referral to hospice care when it might be most helpful.
Recently we have seen the emergence of some new approaches to providing hospice care that have blurred the lines somewhat, but have also made hospice-type services available to a broader range of patients and families. For example, Aetna was concerned about the extremely high costs of end-of-life care and the reluctance of patients, families, and physicians to refer to hospice programs earlier. They tried an experimental program where patients with a life expectancy of less than a year could be accepted into hospice care without giving up any of the treatments that they might choose to continue. The number of patients coming into hospice care just about tripled and the costs for care decreased by a quarter.
The reason these new approaches are so important is that it is very difficult to easily separate patients who have a limited prognosis into two groups: potential hospice patients, and everyone else. By having alternative approaches and programs, more and better care will be provided and more people will be helped. In the latter parts of the Middle Ages there was considerable attention paid to ars moriendi—the art of dying. Until very recently, most people did not have lingering deaths, and more typically, when people contracted a fatal condition they died within days or weeks. Today, most people with serious or fatal conditions can be maintained for much longer times, and this also suggests that we need to think of death and end-of-life care differently than we have in the past. We need to think about a new ars moriendi that is more suited to modern medicine and today’s culture.
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Browse the Publications Library on NationalRegister.org for Dr. Nydegger’s 2009 Article Hospice and Psychology: The Need and the Opportunities