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Ethical Issues of Ethical Issues of Hospice and the Hospice and the
Loss of TechnologyLoss of Technology
Hospice remains committed to
providing care that treats the person, not
the disease, and emphasizes quality of
life, not duration.
What is Hospice?What is Hospice?Follows palliative
care philosophy Goal is in reducing
severity of disease symptoms rather than providing a cure
Offers comfort and dignity to patient dealing with illness
Treats the patient holistically: physically, spiritually, and emotionally.
Reaches out to families and caregivers to provide support
Hospice.. As Told by Lisa Hospice.. As Told by Lisa Heartland requires that you go through 6
hours of trainingSit with patients for 3 hours a week, most
have dementiaSome are actively dyingAlso go to a home for 3 hours a week and sit
with someone in home careMain job= LISTEN LISTEN LISTEN!!Has helped me personally cope with issues
with death as well as being comfortable talking about one’s own death
Sheila Sheila
Sheila, 55 year old female Lupus, Hospice patient Famous quotes by Sheila:
◦ “Hospice is somewhere I never thought I’d be. Sometimes I sit and wonder why this is happening to me, why I’m only 55 and I feel like I should be at home enjoying my life.”
◦ “I just want to go home. The food is terrible here.”◦ “Being in hospice is difficult. You have to come to
terms with your own death. You have to face things that you never thought you would have to face so soon. No one comes to visit me, I’m dying alone.”
◦ Sheila is the youngest person that I have ever volunteered with
Ethical Issues and Ethical Issues and CommunicationCommunication
Ethical Issues within the Ethical Issues within the Hospice SystemHospice System
As with all end of life care, many ethical issues surround hospice and palliative care
Ethical issues involve three major areas:
A respect for patient autonomy Ex. artificial nutrition and hydration Withdrawing and withholding treatment
Access to care and overcoming barriers
A Respect for Patient A Respect for Patient AutonomyAutonomy
Many patients are unresponsive, on life-support
Artificial hydration and nutrition◦ YES or NO?
What would the patient want?Physician-assisted suicideDecision-making is very hard
◦ Lot of uncertainty surrounding it
Barriers and Access to Hospice Care
Communication and Language Barriers
Underutilization by minorities◦ 84% Caucasians◦ 8% African Americans◦ 8% others
Mistrust within the health care system
Lack of knowledgeLack of minority employees
Demographical Features and Demographical Features and Barriers to AccessBarriers to Access
Hospice serves more Caucasian females then any other race or sex
African Americans and Hispanics have been shown to receive less care through Hospice
Middle to lower class seek care through hospice “Identifying and overcoming these barriers is important
in improving access to end of life care now and will become even more critical in coming years,” (Hastings Center Report 1).
“Misperceptions caused by lack of cultural sensitivity and skills can lead to unwanted or inappropriate clinical outcomes and poor interaction with patients and their families at critical junctures as life comes to a close”.
Research has shown that African Americans and Hispanics receive less pain medication then Caucasians
Lack of Information about Hospice Services
In 2004:◦ African Americans represented fewer than 10% of
the nearly 1 million Americans who utilized hospice care (NHPCO, 2004).
◦ Another study evaluated more than 1500 deaths in which 111 decedents were African American and asked families of non-hospice users if hospice had been offered as an option. These investigators found that 68% of the African Americans had not used hospice services, and of these, more than half had not been informed about the availability of hospice (Abdul-Malik et. al., 2004).
Hospice and How Hospice and How Communication is Lost Communication is Lost Through TechnologyThrough Technology
COMPUTERS!COMPUTERS!No human intervention
Everything is done through/on the computer No one talks to each other Instead of having conversations with the staff people
watch TV Loss of communication due to technology is very
apparent
Computers… Good or Computers… Good or Bad?Bad?
Hot or Not?Hot or Not?Positives
◦ Everything kept in a file on the computer and this is organized
◦ Easier then writing it down◦ Easier to read then some of the doctor’s
handwritingNegatives
◦ It’s a strong subculture◦ Ethical issue because people leave files up
and that’s a confidentiality issue◦ Loss of transfer by human hand/word of
mouth
Implications for the FutureImplications for the FutureMore community involvement
◦Hospice promotion: especially targeting minority populations
◦Education of the wide array of services offered by hospice
◦Address misconceptions and issues of mistrust
Thank You for Your Time Thank You for Your Time