Senior Power: “Death hath so many doors to let out life”--Beaumont & Fletcher

By Helen Rippier Wheeler
Monday July 26, 2010 - 10:14:00 PM

An M.D. of my acquaintance assumes that an aged person who does not have money or family will end up in a nursing home. Some folks, including “professionals,” assume that hospice provides assisted suicide. It is currently possible to obtain physician-assisted suicide, albeit not easily, in three states. Think Jacqueline Kennedy Onassis. Popular literature conveys two hospice pictures— an at-home service and a building/program somewhere else. Think Art Buchwald. 


Writing from a Washington, D.C. area hospice during the year before he died, Buchwald reflected on life and death. “Too soon to say goodbye” is his 2006 Random House book, available in the Berkeley Public Library in large and regular print. Chapter titles include On standby for heaven, How I wound up in a hospice, Life at the hospice, Caregivers, The question of death, Mail call, Poster boy, Communication, Death in the afternoon, Awards for staying alive, and Sex and lies. 


Some services have always been available from visiting-nurse and home-care agencies, clergy, church-visitation committees, and other local sources. A hospice program coordinates their services. Not all communities have hospice agencies. Medicaid (California’s Med-I-Cal) and some insurance plans may pay part of the bill. Medicare coverage of hospice care for terminal illness in a Medicare-approved hospice program is described in the Centers for Medicare & Medicaid Services’ 16-page booklet, “Medicare hospice benefits.” Information about the National Hospice and Palliative Care Organization, the National Association for Home Care and Hospice, and the Hospice Association of America and other organizations is also accessible by Internet.  


For patients receiving institutionalized medical care, the federal Patient Self-Determination Act (PSDA) requires that hospitals give registering patients information regarding their right to accept or decline any kind of medical treatment, including life support. A patient can elect to wear a band which directs staff not to resuscitate. “DNR” should appear in one’s chart. (Presumably one would be a patient in a secular hospital. None of this was manifest when I was a local hospital patient in 2005.) 




Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. The term generally refers to any care that alleviates symptoms, whether or not there is hope of a cure by other means. Palliative treatments may also be used to alleviate the side effects of curative treatments, such as nausea associated with chemotherapy


Although the concept of palliative care is not new, most physicians have traditionally concentrated on trying to cure patients, treatments for the alleviation of symptoms viewed as hazardous and inviting addiction and other unwanted side effects. 


There is sometimes confusion between the terms hospice and palliative care. Hospice services and palliative care programs share similar goals of providing symptom relief and pain management. Non-hospice palliative care is appropriate for anyone with a serious, complex illness. In the United States, a distinction is made between general palliative care and hospice care, which delivers palliative care to those at the end of life; the two aspects of care share a similar philosophy but differ in their payment systems and location of services. Elsewhere, for example the United Kingdom, this distinction is not operative: in addition to specialized hospices, non-hospice-based palliative care teams provide care to those with life-limiting illness at any stage of disease. 


The term "palliative care" is increasingly used with regard to diseases other than cancer such as chronic, progressive pulmonary disorders, renal disease, chronic heart failure, HIV/AIDS, and progressive neurological conditions such as Amyotrophic lateral sclerosis (ALS). Think Craig Ewert, Lou Gehrig, Stephen Hawking. In addition, the rapidly growing field of pediatric palliative care has clearly shown the need for services geared specifically for children with serious illness. 




“Death is not the worst evil, but rather when we wish to die and cannot,” declared Sophocles (c. 496 B.C.–406 B.C.) Joy Loverde, director of Silvercare Productions, is concerned about suicide. In her “Complete eldercare planner”, she looks past the elder patient, addresses the family and assumes everyone is ready, willing and able. “Take talks of suicide seriously. Studies reveal that most elderly people who attempt suicide fully intend to die. Failure to complete the act is usually a result of poor planning, not an attempt ‘to get attention.’ Elderly males are the highest risk group….” She provides “clues” to watch for. So much for the right-to-die.  


There can be a relationship between assisted suicide and hospice. The modern concept of hospice includes palliative care for the incurably ill given in such institutions as hospitals or nursing homes, but also care provided to those who want to die in their own homes. It began to emerge in the 17th century, but many of the foundational principles by which modern hospice services operate were pioneered in the 1950s by Dame Cicely Saunders. Although the movement has met with some resistance, hospice has rapidly expanded throughout the United Kingdom and the United States.  




Suicide tourism is associated with the pro-euthanasia movement which organizes trips for potential suicide candidates in the few places where euthanasia is tolerated, encouraging decriminalization of the practice in many parts of the world. It is important because it shows clearly that hospice, whether in one’s home or a separate facility, usually does not suffice for the patient with an incurable deteriorating illness and or extreme pain. This is well demonstrated in PBS remarkable “Frontline” series “Suicide Tourist” aired in March 2010.  


The American Medical Association has issued some related questions: 


1. Should euthanasia or physician-assisted suicide be legal? 


2. Is there a moral difference between passive and active euthanasia? 


3. Do “DNR” orders endanger patients? 


4. What is medical futility? 


5. What is an advance directive? 


6. Does Dr. Jack Kevorkian ethically serve the best interests of his patients? 


7. Is the health care power of attorney sufficient on its own? 










Regarding the “North” Berkeley Public Library (June 29, 2010 “BPL, Wherefore art thou?”), Sylvia Pastano points out that “There are no longer any medical reference books (as we boomers age!), no encyclopedia or dictionary in reference (what kind of reference collection is that?) … went to check something in the Bay Area Consumer Checkbooks and they had all been tossed. That information is not online. The Current Events bulletin board that I relied on to see what was happening in Berkeley has been gone for months. There is no longer a community feel there. The selection of interesting new books seems to be dwindling and the older books on the shelves are also getting pretty thin… There must be other North Branch patrons who are also upset about what is happening…” 




Since 1965, the Older Americans Act (OAA) has gained recognition as a unique and highly regarded statute that has stimulated the development of a comprehensive and coordinated service system. This system has contributed greatly to enhancing the lives of older individuals, family caregivers and persons with disabilities. In 2011, Congress will consider reauthorization and amendments to the OAA effective in FY 2012. In anticipation of this process, the Administration on Aging (AoA) is soliciting input concerning the reauthorization Information on reauthorization events, listening forums, and more can be found on the AoA Web site




Helen Rippier Wheeler can be reached at 


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