AMA media forum praises hospice care
Aims to reduce need for physician-assisted death
The American Medical Association (AMA), often accused of indifference or hostility to the hospice movement, made amends with a well-publicized meeting for journalists in New York City in April.
Officially, the Symposium on End of Life Care, which drew a standing-room-only crowd of 80 reporters and others, was sponsored by the Coalition for Quality End-of-Life Care, not the AMA. But 25 of the coalition’s 46 members are state medical societies. The press release announcing the meeting went out on AMA letterhead. AMA listed itself modestly as a member, under "additional societies."
Symposium participants had only good things to say about hospice.
Timothy Quill, MD, director of the Program for Biopsychological Studies at the University of Rochester (NY), and the lead physician plaintiff in a case now before the Supreme Court, Quill v. Vacco, aimed at legalizing physician-assisted suicide, said that hospice "provides the model for care at the end of life. It is the standard of care for people who are dying. The value of hospice care should guide us throughout this debate."
One reason for praising hospice was a strong emphasis by a number of speakers (and official AMA policy) on opposition to physician-assisted death. "While health professionals have taken critical steps to provide the best possible quality of care for patients facing death, the symposium has identified that there is still room for improvement," said Yank Coble Jr., MD, an AMA trustee and co-moderator of the symposium. "The Coalition for Quality Care believes that with improved care, the call for physician-assisted suicide would be significantly reduced."
The speaker representing the hospice movement at the symposium was Mary Labyak, MSSW, LCSW, executive director of Hospice of the Florida Suncoast in Largo, the largest community-based hospice in the country. The hospice has cared for nearly 50,000 patients in its 20-year history, and last year served over 85% of all patients dying of cancer in its community.
Nationally, the number of hospice providers has grown from one in 1974 to nearly 3,000 today. Hospices cared for 340,000 patients in 1995, nearly 400,000 last year and, at current rates of growth, could approach almost half a million in 1997, Labyak said. That is one of every five dying Americans.
"For 25 years it was questioned why we should improve how people die," Labyak said. "The hospice movement at first was lonely and isolated. Today we have the chance to make the difference," she added, citing research by Lewin-VHI that Medicare saves 52 cents for every dollar it spends on the billion-dollar-plus hospice industry.
Labyak said that while roughly half of the dying patients her agency served expressed a desire or interest in ending their lives, only six or eight were known to have "overtly suicided." Entering a properly run hospice does not destroy hope for a patient, she says. "For many, it is the final stage of growth in life. In many cases, it provides the first opportunity for many family members to say, I love you.’"
The future will see hospices providing "a much broader continuum of services for a longer period," Labyak predicted. One example is the Florida hospice’s recently launched children’s program, which provides children with "the language to talk to grandma." Her hospice now provides counseling for patients in local doctors’ offices and education for professionals. It also has signed a contract to have hospice care include in the curriculum of a local medical school.
Another speaker, Kathleen Foley, MD, co-chief of the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center in New York City, said one impetus for the growth of the hospice movement was the realization that American medical care had ignored the needs of patients who were clearly near the end of life. "It has been a system of care that focuses only on active treatment," Foley said. "In this system, the patient fails the care, it’s not the care failing the patient." Many hospitals and doctors have simply refused to recognize that a patient is dying, which is one reason why suicide is the eighth leading cause of death in the United States, she said.
Foley congratulated the AMA "for recognizing that doctors need more information on the end of life. Too many don’t care about a dying patient. The hospice movement has been the rallying point to identify the needs of dying patients and to learn how to provide for those needs."
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