The word “hospice” alone, to say nothing of the actual care hospice provides, is widely misunderstood. Most people generally know that hospice takes care of people that are dying. But as to the details, there is much that is gotten wrong.
Here are four hospice myths that people hold and some clarifying information to dispel them.
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Hospice kills. A person comes onto the hospice program and within days the hospice personnel ends the person’s life.
Putting aside the misconceptions around narcotic use that lead people to think that “hospice kills,” people can think the purpose of hospice, generally speaking, is to end a person’s life as quickly as possible. That is an idea that circulates. I see this belief as stemming from lack of proper teaching on the part of the hospice personnel, teaching about narcotic use and the outcomes at end of life.
Aside from the legality of killing patients intentionally, a logical reason that hospice does not intentionally kill its patients is that the hospice is reimbursed mainly on a per day, per patient basis. The longer the person is in service, the more money the hospice makes. Most of the money received is spent in the first week and last week of service. The time in between is what pays for all the late referrals and those that die as soon as they come on service. It is not in hospice’s best interest financially, let alone ethically, to kill its patients. The goal of hospice care is NOT to end life, but to provide the highest quality of life until death comes.
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When hospice care begins, medical care is stopped and a person is just set aside to die.
Hospice provides comfort care when actively pursuing treatment and cure are no longer considered viable options. Comfort care addresses symptoms caused by the progressing disease. Comfort care’s goal is to provide physical care, support, education and guidance – not just for the patient but for the family and significant others.
Hospice services strive to help a person and their family live the best life they can within the confines that the disease has put them in. Comfort care is not just about physical care, but emotional, mental, and spiritual care for all.
3. If I stop medical treatments then I am saying I want to die. I’m giving up.
Everybody dies. Our body is programmed to die and actually begins dying the moment we are born. We just don’t like to think about dying. In fact we often think if we talk about dying then we will surely die. We avoid the “d” word throughout most of our lives. It is often because of this innate fear of dying, of the unknown, that we seek as much treatment as we can find, even when the chances of success are slim.
Hospice implies giving up AND yes, it is stopping active treatments. Yes, it is saying I am going to die sooner than I wanted. Yes, it is admitting that life will end.
Choosing hospice is not saying I want to die, or even that I am ready to die. It is acknowledging the inevitable and taking the opportunity of support for yourself and significant others.
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If hospice gives me morphine, I will become addicted and probably die of an overdose.
There are so many misconceptions regarding the use of morphine in end of life care. Fear of addiction and overdose are two of the main ones.
Taking care of someone at the end of life is different from taking care of someone who is going to get better, yet so much of end of life care is judged by how people get better. Taking a narcotic at end of life has different dynamics than taking a narcotic in an acute care situation.
At end of life, pain from the disease is dealt with differently. One of the reasons pain management is different is because the body is shutting down. The organs are not functioning normally so the medications are not absorbed throughout the body in a regular, timely manner. Dosage amounts and how often they are administered are guided by the body, unlike scheduled administration in the acute care setting.
Overdosage: There is a thin line in everyone’s body between pain and no pain. Our goal in end of life pain management is to find that line of division. Not enough medication, there will still be pain. Too much medication, and there will begin the signs of overdosing. The signs of an overdose are graduated. They begin with increased sleeping, progress to slurred speech, confusion, delusions, slowed breathing, and finally death. There are many signs along the timeline that tell us there is too much. What do we do when those early signs appear that say there is more medicine than pain? We reduce the next dose amount.
Addiction is the result of having more narcotic in the body than pain. It is that simple. When you are consistently taking a dose of narcotics that exceeds the amount of pain experienced, addiction follows. Put very simply: addiction occurs when it does not have pain to work on.
I will add, and I do not mean to sound insensitive, that the concern about addiction during end of life care is really debatable. Death will be coming in a matter of weeks, days or hours. Even if it would possibly be months before death, isn’t comfort the issue rather than the unlikely possibility of addiction?
Something more… about 4 Myths About Hospice—and the Truth That Brings Comfort
If you or someone you care about is facing the end of life, knowing what to expect can ease the fear. Understanding what hospice really offers—what it does and doesn’t do—can bring comfort, guidance, and peace of mind. Here are resources to support you on this journey: Gone From My Sight: The Dying Experience – The most widely used hospice resource in the U.S., explaining the dying process simply and clearly. The Final Act of Living – A deeper look at the physical, emotional, and spiritual changes that come with end of life, and how to care for someone through it. And New Rules For End of Life Care – A compassionate video/dvd that helps families and caregivers know what to expect and how to support. Great for training new staff as well.
