Will assisted suicide kill hospice?’
Hospice needs to sell’ its vision of dying
A provocative article in the current Hospice Journal1 written by Arthur L. Caplan, PhD, medical ethicist and director of the Center for Bioethics at the University of Pennsylvania in Philadelphia, asserts that assisted suicide represents a serious threat to hospice’s survival.
"The hospice movement in America is in big trouble. It stands a good chance of becoming the first victim of the burgeoning movement to legalize assisted suicide," he writes.
The problem is that while hospice seems an attractive alternative to extraordinary and invasive medical treatment for dying patients, legalized assisted suicide would irrevocably alter the equation and could threaten the foundation of trust that is essential to hospice’s functioning. In fact, the two approaches "are unlikely to coexist for very long," he continues.
For Caplan, the public demand for assisted suicide has less to do with pain and suffering than with issues of cost, fear, and guilt. Patients fear they will lack the willpower to end their own lives, and they want to be relieved of the personal moral burden traditionally associated with taking one’s life, preferring to transfer it to their doctors. For many, the mere fact of physical impairment is enough to warrant assisted suicide, regardless of whether the pain and physical suffering could be relieved. "Eventually, hospice programs will either have to incorporate assisted suicide into their care plans or risk elimination by new forms of terminal illness care which include assistance in dying for those who request it," he concludes.
Caplan tells Hospice Management Advisor that he is not an advocate for assisted suicide. "I don’t think it’s a good idea. But I think it’s inevitable, and hospices are going to face very quickly the question of whether they will participate or not. If not, they will need to convince people why a slower, more prolonged death is preferable to a more accelerated one." Some hospices may decide to offer assisted suicide as a last step, but they will find themselves competing with medical providers who offer it as a first step. Simply labeling hospice as the positive alternative will not be persuasive, he adds.
"Consumers are overwhelmingly likely to choose the [simpler] approach of assisted suicide unless they are sold on the benefits of hospice’s form of dying," he explains.
"I think hospice has a fine vision of the opportunities at the end of life, but that vision needs to be sold. It’s not part of the culture’s current expectations," Caplan adds. "Hospice will be in a battle that it is not preparing for. It needs to be clear on its vision of what a good death is, and it must develop a vision of where and when assisted suicide fits into that picture."
Reference
1. Caplan, AL, Will assisted suicide kill hospice? Hospice Journal 1997; 12:17-24.
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