kathy1951 Posted November 2016

When is hospice euthanasia?


I am starting a new post because the previous one on "death hastened by hospice" has so many replies. Do people expect medical euthanasia when they accept hospice? Does hospice staff aim for 24/7 sleep using sedating meds? When did this become the standard of care? When we call hospice should we be prepared to have our loved one be medicated heavily and die soon? Why is the word "comfortable" left so open to interpretation? Why is "agitated" as minor as slight tossing and turning during sleep? What has happened to hospice?



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freqflyer Nov 2016
Hospice does not do medical euthanasia, in fact there are some patients who graduate from Hospice and live on for many more years.

A person's death is the same timetable whether Hospice is there or not. With Hospice one knows that their love one will be transitioning without pain.

Both my parents were on Hospice as there wasn't anything medical more the doctors could do, my parents were in their final chapter. And I was thankful that both passed very peacefully.

Kathy it is my understanding that you are a MD. Therefore you would know that it would take 200mg of morphine to take out someone. Hospice uses between 5-20mg Q 2-4 hrs for patient care.

JessieBelle Nov 2016
I do hope the moderators delete this redundant and disrespectful thread.

It's not. Period.

I agree with FF and Jessie.

Kathy, I read portions of your other post and what you considered improper care by hospice. I am sorry for your loss, and for the unpleasant experience you had.

jeannegibbs Nov 2016
Never. Hospice is never euthanasia. Every now and then you read about some medical person killing patients. That is not legal. We typically read about it because when it comes to light the nurse or doctor or cleaning person or whoever was doing it has been arrested. So I cannot say there has never been a hospice worker who believed in euthanasia but it is certainly not a sanctioned part of the program.

My husband was on hospice care in our home. He slept a lot, as part of the disease process, not from drugs. His pain was mental anguish not physical pain and I sometimes used the drugs provided for that, with my husband's agreement. ("Do you want me to give you something to help you feel calmer?" "Yes please.")

My husband was on hospice about 5 weeks, before he died peacefully in our bedroom, holding my hand. The hospice people were very surprised when I called them. They thought he had several more weeks. The doctor reading the autopsy report was surprised that he made it as long as he did. What is happening internally is not always apparent from the outside.

My mother was on hospice care in a nursing home for a few months. She got extra care and attention. The hospital thought she may only have days to live, but obviously they were wrong. Mother continued to improve and was discharged from the hospice program. She lived another year, and when she did die it was so sudden that hospice wasn't in the picture at all.

When someone is accepted for hospice, it is the medical opinion that they are likely to be within 6 months of dying. Obviously that is an opinion and can be wrong, but it is based on experience and statistics. So if you have a loved one on hospice be prepared for their death. If they are in pain or severe anxiety expect that drugs will be available to minimize that.

With my husband, in our home, I was in charge of deciding when to use the drugs.

My husband's dementia had progressed to the point he was sleeping more and more. When he was sleeping 20 hours a day we called in hospice. I did nothing to make him sleep more, and engaged him when he was awake. I don't know why you think using sedating meds has become the standard of care. That wasn't the case for either my mother or husband.

Should you expect your loved one to be medicated heavily? Maybe, if that is what it takes to keep them out of distress. But not if it isn't necessary. Should you expect them to die soon? Yes. That expectation is part of the criteria for being admitted. But in a large number of cases the person does get better and leaves the program without dying.

I suppose there are bad situations in some hospice practices, as there are in some hospitals or clinics or nursing homes, etc. But the program itself is not euthanasia.

kathy1951 Nov 2016
I wish so sincerely that I had the loving and wonderful experience with hospice that many of you have had. My heart is bursting with the pain of what occurred, and it hurts even more that this question is seen as disrespectful at all. Maybe the only answer is that for almost everyone, it is never euthanasia.

Veronica91 Nov 2016
Kathy I have only my experience as a hospice nurse to answer this question.
Hospice care is supposed to be directed by the patient or their representative usually the primary caregiver. There are things that hospice can and will do to ensure the comfort of the patient. 24 hour sedation is not one of them.
As you are aware there is a standard pyramid for the use of pain relieving medications and narcotics are being increasingly more tightly controlled because of the increasing abuse
The horrible cocktail of medications you describe as being given to your mother
was not our standard of care. Yes they were available either prescribed by the patient's primary physician or the hospice MD. Liquid morphine and Ativan were the drugs of choice. They were not automatically ordered and the doses started were very small. The morphine 20mg per ml .25 ml to 2ml every 2-4 hours. the dosing within that range was at the discretion of the RN. This was started if the patient was complaining of pain and many patients came to us on very low dose morphine who had breathing problems to ease their discomfort. Painful conditions at admission were usually already being treated by narcotics and the were continued and if not effective changed or increased. The goal was an extended release medication such as a fentynal patch with a short acting breakthrough being available. An order for an increase in the extended release dose was obtained if necessary based on the number of doses of the breakthrough medication that had been used in the previous 24 hours. Very large doses were sometimes needed when patients became tolerant to the medications. Doses that you as a physician would never prescribe in regular practice but requests to keep the patient totally sedated till death were not honored. Should that be approved and in ten years I never saw it done, the patient had to be admitted to the hospital and properly monitored.
Anxiety and agitation as you know are common in the dying patient and part of comfort care is to try and relieve both these fears and the more severe agitation where the patient in yelling and flailing totally out of control. Many patients would be admitted already on anti depressants and anxiolitics. Slight restlessness was not an indication but they could be used for night sedation. If a patient became uncontrollable at home the patient would be admitted to the hospital with the family's permission. i personally have had to call the police to facilitate that and I expect you have had patients brought to the ER in this condition.
I understand your sister wanted this level of sedation and for some reason the hospice complied in spite of your oposition. It does indeed sound as though this hospice did act as a death squad and their practice sounds like the infamous "Liverpool pathway" practiced for a time in the UK which was horrific and as an English trained RN could not understand how it was tolerated.
On reflection a whole conspiracy of events combined to lead to your mother's death and totally understand your wish to make it known that this was what happened and alert others to be vigilant. This applies to all branches of medicine these days because medicine has become so specialized and compartmentalized that no one seems able or knowledgeable to view the whole picture.
I do hope you find some answers to your concerns they are certainly deserved.

pamstegma Nov 2016
With or without Hospice, the patient is dying soon. They have the right to choose hospice or not. The patient can sign a MOLST specifying exactly which treatments they want at the end. What I have seen is that family members end up divided. One side says "let her go" and the other side says "you're killing her."
Euthanasia is different. It's the massive overdose using 390mg (1ml) of pentobarbital per 10lbs of animal, injected in a vein. Roxanol, used in hospice is dosed 20mg/5ml. So if you drip 1 ml in, that's only 4mg. Not lethal.
Those who scream the loudest are the relatives who appear at the last minute, unaware that mom or dad are so close to leaving. Very sad for them, lots of fear, obligation and guilt converge at once. It can drive families apart for a long time, even permanently.
You don't NEED Hospice. If you can witness death and not let it affect you, go ahead without it. It's a personal choice, no more, no less.

jeannegibbs Nov 2016
Veronica91, thank you for that insider view.

Kathy, I am very surprised you weren't given more say over what drugs your mother was given. I (with no medical training) had control over what to give my husband. When the comfort kit was explained to me I said, "I won't be using the haldol. It is not to be used for people with lewy bodies." I gave them the brochure on the subject and the wallet card saying my husband should never be given it. The hospice folks had never heard this and seemed very interested in the literature I gave them. The social worker said, "It is a standard part of the kit, and I'm not sure we can leave it out, but you certainly do not have to use it." As it turned out, when the kit arrived a few hours later it did not contain haldol.

My mother had had some previous bad reactions to morphine and hospice did not use it for her.

So in my experience, the patient or the primary caregiver has power over what is given. I am very surprised you did not have the opportunity to oversee your mother's meds.

Actually, if you expected her to live another 2 years, and her doctors had to stretch the definitions to say she'd die in 1 year, I don't understand what she was doing on hospice at all. That is for people expected to die within 6 months.

So your situation is confusing to me. But I am terribly sorry for the very distressing experience you had with hospice.

Midkid58 Nov 2016
True Hospice is NEVER euthanasia. It is the care one receives at the end of life to make the passage into the next life more comfortable and pain free as possible.

Now, if a DR asks if the family wants him/her to "help "dad" along....then perhaps it's a different story. I do believe my FIL's oncologist gave him an overdose of morphine that allowed his poor, sick body to let go. Do I have proof? No, and I don't want any. Dad was drowning in the fluid accumulating in his lungs faster than they could suction it out. He could not speak, he was comatose, but still fighting everyone--the morphine just helped him along. He had, at most, a day or two of total misery left. I wouldn't let my beloved dog live like that, much less a person I loved. He passed 10minutes after the IV was injected with whatever the dr put in it. I thank him to this day for not letting dad suffer any more.

And, yes, the prodigal son did not take us seriously and did not make it to the "death bed". He regrets that to this day.

zythrr Nov 2016
Hospice=Money, plain and simple.

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