“… we must be wary of those who are too willing to end the lives of the elderly and the ill. If we ever decide that a poor quality of life justifies ending that life, we have taken a step down a slippery slope that places all of us in danger. There is a difference between allowing nature to take its course and actively assisting death. The call for euthanasia surfaces in our society periodically, as it is doing now under the guise of “death with dignity” or assisted suicide. Euthanasia is a concept, it seems to me, that is in direct conflict with a religious and ethical tradition in which the human race is presented with ” a blessing and a curse, life and death,” and we are instructed ‘…therefore, to choose life.” I believe ‘euthanasia’ lies outside the commonly held life-centered values of the West and cannot be allowed without incurring great social and personal tragedy. This is not merely an intellectual conundrum. This issue involves actual human beings at risk…”
— C. Everett Koop, M.D. * *taken from the book KOOP, The Memoirs of America’s Family Doctor by C. Everett Koop, M.D., Random House, 1991
Florence Wald and American Hospice
Florence Wald is the most famous leader of the modern American hospice movement. She was born Florence Sophie Schorske in New York on April 19, 1917. She received a B.A. from Mount Holyoke College in 1938 and an M.N. from Yale School of Nursing in 1941. She received a second master’s degree from Yale University in mental health nursing in 1956, and became an instructor at the school’s nursing program. In 1959, she became Dean of Yale’s School of Nursing. The Yale School of Nursing was founded in 1923 with funding from the Rockefeller Foundation.
Wald’s entrance into hospice came about after she attended a 1963 lecture at Yale by Dr. Cicely Saunders, founder of St. Christopher’s Hospice in London. Saunders’ lecture emphasized minimizing pain in terminal cancer patients so that they could focus on their relationships and prepare for death. Wald immediately began reshaping the nursing school curriculum to put more focus on patients and their families and to emphasize care of the dying. Feeling further effort was required, Wald resigned as dean and went to London to study at St. Christopher’s. Upon her return, she organized the first U.S. hospice in Branford in 1971. Connecticut Hospice, which began by offering in-home care but eventually built its own inpatient facility, became a model for hospice care here and abroad.
Florence Wald, an agnostic and secular humanist, was an open advocate of euthanasia and assisted suicide, while Saunders, a devout Christian, opposed the practice and believed hospice made it unnecessary.
As productive and influential as Florence Wald was, she sharply disagreed with Dame Cicely Saunders’ life-affirming approach to end-of-life care and said: “I know that I differ from Cicely Saunders, who is very much against assisted suicide. I disagree with her view on the basis that there are cases in which either the pain or the debilitation the patient is experiencing is more than can be borne, whether it be economically, physically, emotionally, or socially. For this reason, I feel a range of options should be available to the patient, and this should include assisted suicide.”
So, is Wald saying assisted suicide should be made available for society’s economic needs? Or perhaps she’s referring to the family’s inheritance? Economic because it costs the family too much or the health care system too much? Social reasons because a dying family member is a stressful situation on the family?
Wald’s pro-euthanasia type of hospice is what is being delivered in many parts of this country, though many hospice professionals will strongly deny that. Those who do remain faithful to Dr. Saunders life-affirming vision, who relieve the suffering of the dying until a natural death occurs in its own timing, will say they do not hasten death. Those who do hasten death will say the same. The public often has no way of knowing which type of hospice their loved one will experience.
Many hospice leaders have spoken out against euthanasia and assisted suicide, and the whole American hospice movement has rapidly expanded since its inception. In 1983, Congress required Medicare to pay for hospice care, which put the treatment in mainstream medical practice. According to the Center for Nursing Advocacy, in 2010 over 5,100 hospice programs served nearly 1.6 million patients a year in the United States.
Hospice was once a grass-roots, home-based model of end-of-life care, but is now part and parcel of corporate medicine. In 2005, for-profit organizations accounted for half of all hospices, and they charted profits of about 12 percent from 2001 to 2005, according to the Medicare Payment Advisory Commission (MedPAC).
Hospices that remain true to the Cicely Saunders’ life-affirming mission will not hesitate to proclaim the sanctity of life, while they intervene to relieve suffering at the end-of-life. Those for-profit and volunteer hospices that are willing to hasten death normally do not speak about the sanctity of life, and they do not teach their staff to never impose death. In fact, their training results in quite the opposite. The hospice industry has marketed itself as this “compassionate thing” that exists all over the country and is filled with angelic staff who care and work the kind of wonders Dame Saunders encouraged.
There are thousands of stories of wonderful care received from hospices and how the patient and the family have benefited. There are also thousands of stories of patients being put to an early death by overdosing with pain cocktails or by dehydration and starvation. There has been a very slick, sophisticated and well-financed campaign to completely twist the positive contributions of hospice into something the public would never openly accept.
To be perfectly clear, water and sustenance are not heroic efforts to keep the dying alive. This is keeping the patient comfortable. When sustenance cannot be delivered, at least hydration can be given to keep the body comfortable. However, there comes a point where the patient’s body shuts down, and neither food nor water are desired or taken and death is imminent.
Palliative Care and Terminal Sedation
Palliative care is not exclusively practiced in a hospice. It is the specialization in the field of medicine which relieves the distressing symptoms of any serious illness at any stage of life, whether terminally ill or not. The World Health Organization states that:
“Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
Terminal or palliative care is used by a majority of hospices today. This often involves permanently sedating the patient, allowing the patient to dehydrate and die. It looks outwardly peaceful as the patient is made to sleep in a medically-induced coma, but the patient’s death is the result. Terminally-sedating the patient is something that can be done in hospice that doesn’t outwardly appear like euthanasia where a lethal agent is given. (Morphine is the potent opiate which directly effects the central nervous system. It has neurotoxic effects on the brain. Overdoses lead to asphyxia and respiratory depression. It slows metabolism, causes incontinence, and has acute and chronic effects on the endocrine system, blood, the heart and lungs. The hospice “cocktail” usually consists of Ativan, Haldol and Morphine). It also doesn’t outwardly appear like assisted suicide where a patient takes a lethal medication prescribed by a physician. Terminal sedation is more subtle and deceptive. This is what happened to my friend’s relative who I told about in Part 3. The man wanted to be with his family, but food and water was denied by hospice. (Yes, there are hospices that refuse to give any food or water and you must sign on to that when they are hired.) The sedating “cocktails” were given to the point where respiratory function was decreased enough to cause early death.
Palliative medicine is commonly used by hospice to relieve many symptoms of the dying patient. It is precise and tuned especially for each patient’s illness. However, there are facilities wherein every patient is sedated because all the patients are “agitated.” It is a perversion of hospice as well as palliative care. It is a deliberate railroading of patients to an imposed death, a hastened death through “palliative” or “terminal” sedation.
Surprising to many, terminal, palliative or “total” sedation is so commonly used today to hasten death (a method of stealth euthanasia) that it is defined by the pro-euthanasia Compassion and Choice’s “Good to Go Resource Guide” glossary. They define it as:
“the continuous administration of medication to relieve severe, intractable symptoms that cannot be controlled while keeping the patient conscious. This treatment renders the patient unconscious and relieves suffering by inducing an artificial coma. The unconscious state is maintained until death occurs.”
Unfortunately, it is used way too often on patients who are not having severe, intractable symptoms that cannot be controlled while they are conscious.
Ron Panzer of Hospice Patients Alliance states, “In many cases, the Adult Protective Service system is even used to intimidate those who truly care about the patient and object to clinically unnecessary or harmful interventions. These can be as common as giving morphine when there is no pain, sedating a patient who is not agitated, depriving the patient of needed medications when they are still benefiting from them or not providing food and fluids as needed when they patient is still benefiting from them. We have received many calls from families who tell us the hospice falsely accused them of being a threat to their own loved one and called APS when they voiced their objections to the death-protocols being implemented at the hospice. So we have those who truly care about the patient being accused of being a threat, and those who hasten death in charge of the agency entrusted to care for the patient!”
Euthanasia Society and Hospice
Many supporters of the sanctity of life simply do not know how deep this all goes and how successful the heirs of the original Euthanasia Society of America have been in our nation. They do not know how the Euthanasia Society is connected with the largest segment of the hospice industry in America, and when some have finally understood it, they have been shocked. Most of those who affirm the sanctity of life view hospice as the rightful alternative to euthanasia and assisted suicide. Sadly, this is becoming a rarity.
The largest hospice organization in our nation is the successor organization to the Euthanasia Society of America. According to the most prominent hospice leaders in the world, many hospices in the United States today have no reservations about hastening death through “terminal sedation,” or “palliative sedation.” Federal regulations governing hospice are far fewer in number than those protecting patients in nursing homes or hospitals, or that state agencies inspect hospices less frequently than nursing homes or hospitals. Some hospices may go years without being inspected at all. Because of the HIPAA privacy regulations, nobody interested in researching what is actually going on in hospice can get access to the data, so hospices that have an agenda can act without any outside interference or supervision.
Unlike Dame Cicely Saunders, a majority of leaders at the top of today’s hospice certainly look nothing like the sanctity-of-life hospice Dr. Saunders founded, yet they pretend to be. They are what we call utilitarians, interested in the profits, and expansion of their influence and business. The leaders at the top of the National Hospice & Palliative Care Organization (“NHPCO”) are the Euthanasia Society of America’s heirs and benefactors philosophically. The NHPCO is legally and corporately the final successor organization of the Euthanasia Society in the very strictest sense of the terms.
The Euthanasia Society of America successors, especially in hospice, are now proceeding with their plan to implement stealth euthanasia for citizens whose “quality of life” is deemed “unworthy of life.” The elderly and severely disabled are the targets, which feeds right into Obama Care. They don’t and won’t have to be the “very” elderly or “very” disabled. With Obama Care it will be the “not-so-elderly” (even 60 years old) or disabled, being placed in hospice and dying shortly thereafter, even though they had no terminal illness at all. Others have warned about these developments:
“In an era of cost control and managed care, patients with lingering illnesses may be branded an economic liability, and decisions to encourage death can be driven by cost. As Acting U.S. Solicitor General Walter Dellinger warned in urging the Supreme Court to uphold laws against assisted suicide: “The least costly treatment for any illness is lethal medication.”
Here is the succession of name changes the Euthanasia Society of America has gone through. It is from Ron Panzer’s book, “Stealth Euthanasia, Health Care Tyranny in America.”
Several people who work with the elderly and dying have contacted me with first hand stories of what they’ve seen with hospice care. Others have been family members who have witnessed the lack-of-care in nursing homes and hospitals, as well as the euthanasia tactics of many hospice care givers. Still, some have been treated to wonderful care, the sanctity-of-life treatment Dame Cicely Saunders wanted for all of us who will eventually face death.
In Part 6, we’ll look at the origin of “Living Wills,” the changes to Medicare/Medicaid, and the non-profit and for-profit Hospice organizations and salaries.
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