Mercy's Shadow

Hospice Care and Ethical Principles

Detective Inspector Sarah Patel was called to the scene of a mysterious death at a hospice center. The victim, identified as 72-year-old John, had been a resident at the hospice for the past three months due to his terminal illness.

Sarah interviewed the staff members and reviewed the patient records. She discovered that John’s condition had been stable for the past few weeks, and he was receiving regular hospice care.

However, she noticed a discrepancy in his medication records. It appeared that his pain medication had been altered, and the dosage had been increased beyond the prescribed amount. Sarah suspected foul play.

She questioned the hospice nurse, Emma, who had been responsible for administering John’s medication. Emma initially denied any wrongdoing, but when Sarah pointed out the discrepancy in the records, she broke down and confessed.

Emma explained that John had been in extreme pain and was suffering from severe depression. She felt sorry for him and wanted to help ease his pain. She believed that increasing his medication dosage would provide him with some relief.

Sarah explained to Emma that increasing the dosage without the proper authorization was a violation of hospice care protocol and could have caused harm to the patient. She also reminded her that the hospice’s primary goal was to provide comfort and dignity to patients in their final days.

Emma was arrested and charged with professional misconduct and involuntary manslaughter. The incident served as a reminder to all healthcare providers that hospice care is a crucial healthcare option for terminally ill patients, and they must adhere to the ethical principles of beneficence and nonmaleficence while respecting patient autonomy. Hospice care focuses on both the quantity and quality of life, providing comfort, support, and dignity during the end-of-life process. Any deviation from this can result in serious consequences, and healthcare providers must be vigilant to prevent such incidents.

CORRECT! 🙂

[23:1] The word “hospice” comes from the Latin word hospitum, which means hospitality or place of rest and protection for the ill and weary. The first hospice came to the United States from London in 1974 and developed outside of mainstream medicine in response to the excessive use of technology for extending the quantity of life at the expense of quality of life. Technology has had the unintended consequence of creating chronic illnesses, extended hospitalizations, and dying alone in the hospital without family and friends.

Wrong 😕

[23:1] The word “hospice” comes from the Latin word hospitum, which means hospitality or place of rest and protection for the ill and weary. The first hospice came to the United States from London in 1974 and developed outside of mainstream medicine in response to the excessive use of technology for extending the quantity of life at the expense of quality of life. Technology has had the unintended consequence of creating chronic illnesses, extended hospitalizations, and dying alone in the hospital without family and friends.

CORRECT! 🙂

[23:1] The word “hospice” comes from the Latin word hospitum, which means hospitality or place of rest and protection for the ill and weary. The first hospice came to the United States from London in 1974 and developed outside of mainstream medicine in response to the excessive use of technology for extending the quantity of life at the expense of quality of life. Technology has had the unintended consequence of creating chronic illnesses, extended hospitalizations, and dying alone in the hospital without family and friends.

Wrong 😕

[23:1] The word “hospice” comes from the Latin word hospitum, which means hospitality or place of rest and protection for the ill and weary. The first hospice came to the United States from London in 1974 and developed outside of mainstream medicine in response to the excessive use of technology for extending the quantity of life at the expense of quality of life. Technology has had the unintended consequence of creating chronic illnesses, extended hospitalizations, and dying alone in the hospital without family and friends.

CORRECT! 🙂

[23:2] Hospice benefits include access to a multidisciplinary treatment team specialized in end-of-life care and can be accessed in the home, long-term care facility, or the hospital. In 1982, federal Medicare started funding Medicare beneficiaries who had a prognosis of less than six months to live as verified by two practitioners. State Medicaid and private insurance soon followed suit. After six months, the patient can continue to get hospice care if the hospice medical director or doctor certifies (at a face-to-face meeting) that the patient is still terminally ill with a prognosis of less than six months to live.

[23:3] Although hospice is known for palliating a terminally ill patient’s pain and symptoms, hospice care also provides for many other needs such as a hospital bed for the home, psychological counseling, family bereavement counseling, and other quality of life products and activities.

Wrong 😕

[23:2] Hospice benefits include access to a multidisciplinary treatment team specialized in end-of-life care and can be accessed in the home, long-term care facility, or the hospital. In 1982, federal Medicare started funding Medicare beneficiaries who had a prognosis of less than six months to live as verified by two practitioners. State Medicaid and private insurance soon followed suit. After six months, the patient can continue to get hospice care if the hospice medical director or doctor certifies (at a face-to-face meeting) that the patient is still terminally ill with a prognosis of less than six months to live.

[23:3] Although hospice is known for palliating a terminally ill patient’s pain and symptoms, hospice care also provides for many other needs such as a hospital bed for the home, psychological counseling, family bereavement counseling, and other quality of life products and activities.

CORRECT! 🙂

[23:4] The practice of practitioners having end-of-life discussions with their Medicare patients about end-of-life care, living wills, and advanced directives were politicized in 2009 as “death panels.” The provision for paying practitioners for end-of-life practitioner counseling was, as a consequence, removed from the 2010 Patient Protection and Affordable Care Act, also known as PPACA, ACA, or Obamacare. A randomized trial published in 2010 in the New England Journal of Medicine showed that hospice increased patients’ quality of life and had the unexpected result of increasing the quantity of life, over and above traditional patient care. This debunked the notion that patients who choose hospice died sooner albeit more comfortably than those who choose more traditional care.

Wrong 😕

[23:4] The practice of practitioners having end-of-life discussions with their Medicare patients about end-of-life care, living wills, and advanced directives were politicized in 2009 as “death panels.” The provision for paying practitioners for end-of-life practitioner counseling was, as a consequence, removed from the 2010 Patient Protection and Affordable Care Act, also known as PPACA, ACA, or Obamacare. A randomized trial published in 2010 in the New England Journal of Medicine showed that hospice increased patients’ quality of life and had the unexpected result of increasing the quantity of life, over and above traditional patient care. This debunked the notion that patients who choose hospice died sooner albeit more comfortably than those who choose more traditional care.

CORRECT! 🙂

[23:5] Hospice is an autonomous option for patients who have a terminal prognosis of less than six months to live. Any treatment towards the regaining of health has been determined to be highly unlikely and therefore futile. This is the opportunity for the patient to freely choose quality of life measures that are in line with the medical standards of care. It is also the opportunity not to die alone but to die in the presence of family, friends, and loved ones.

Wrong 😕

[23:5] Hospice is an autonomous option for patients who have a terminal prognosis of less than six months to live. Any treatment towards the regaining of health has been determined to be highly unlikely and therefore futile. This is the opportunity for the patient to freely choose quality of life measures that are in line with the medical standards of care. It is also the opportunity not to die alone but to die in the presence of family, friends, and loved ones.

CORRECT! 🙂

[23:7] Social justice (fair distribution of benefits and burdens) recognizes the value of the patient’s liberty not to pursue ineffective and futile treatments and not to die in isolation. Hospice focuses on the palliation of pain and symptoms and passing away in the presence of family and friends, along with bereavement counseling.

Wrong 😕

[23:7] Social justice (fair distribution of benefits and burdens) recognizes the value of the patient’s liberty not to pursue ineffective and futile treatments and not to die in isolation. Hospice focuses on the palliation of pain and symptoms and passing away in the presence of family and friends, along with bereavement counseling.

Wrong 😕

Explanation: The correct answer is that end-of-life discussions are an important aspect of patient care and can help patients make informed decisions that are in line with their values and preferences [23:4]. The option of avoiding end-of-life discussions is wrong because doing so can lead to patients feeling confused and uncertain about their options, and can lead to healthcare providers making assumptions about the patient's preferences [23:4]. The politicization of end-of-life discussions has had a negative, not a positive impact on patient care, causing many patients to feel hesitant about discussing their preferences and limiting their access to important information [23:4]. Despite the politicization of end-of-life discussions, healthcare providers should encourage their patients to discuss their preferences and provide them with the information they need to make informed decisions. Lastly, it is incorrect that hospice patience die sooner, because a randomized trial published in 2010 in the New England Journal of Medicine showed that hospice increased patients' quality of life and had the unexpected result of increasing the quantity of life, over and above traditional patient care [23:4]. This study debunked the notion that patients who choose hospice care are more likely to die sooner than those who choose traditional care. 

CORRECT! 🙂

Explanation: The correct answer is that end-of-life discussions are an important aspect of patient care and can help patients make informed decisions that are in line with their values and preferences [23:4]. The option of avoiding end-of-life discussions is wrong because doing so can lead to patients feeling confused and uncertain about their options, and can lead to healthcare providers making assumptions about the patient's preferences [23:4]. The politicization of end-of-life discussions has had a negative, not a positive impact on patient care, causing many patients to feel hesitant about discussing their preferences and limiting their access to important information [23:4]. Despite the politicization of end-of-life discussions, healthcare providers should encourage their patients to discuss their preferences and provide them with the information they need to make informed decisions. Lastly, it is incorrect that hospice patience die sooner, because a randomized trial published in 2010 in the New England Journal of Medicine showed that hospice increased patients' quality of life and had the unexpected result of increasing the quantity of life, over and above traditional patient care [23:4]. This study debunked the notion that patients who choose hospice care are more likely to die sooner than those who choose traditional care. 

Wrong 😕

Explanation: Hospice care can be accessed in the home, long-term care facility, or hospital [23:2], and a DNR order is not a requirement for hospice; the only requirement for Medicare hospice is a prognosis of less than six months of life [23:8]. Option D is incorrect because continuing aggressive chemotherapy is unlikely to be effective and may cause more harm than benefit, especially considering the complications Ms. Rodriguez is experiencing [23:5]. The correct answer is that hospice care can not only provide relief from pain and symptoms but also a range of other services to improve quality of life, such as a hospital bed for the home, psychological counseling, and family bereavement counseling [23:3]. Hospice is an autonomous option for patients who have a terminal prognosis, and it respects the patient's goals, values, and priorities, maximizing their best interests during the end-of-life stage [23:5-6]. Hospice care also promotes social justice by focusing on palliation and bereavement counseling [23:7].

CORRECT! 🙂

Explanation: Hospice care can be accessed in the home, long-term care facility, or hospital [23:2], and a DNR order is not a requirement for hospice; the only requirement for Medicare hospice is a prognosis of less than six months of life [23:8]. Option D is incorrect because continuing aggressive chemotherapy is unlikely to be effective and may cause more harm than benefit, especially considering the complications Ms. Rodriguez is experiencing [23:5]. The correct answer is that hospice care can not only provide relief from pain and symptoms but also a range of other services to improve quality of life, such as a hospital bed for the home, psychological counseling, and family bereavement counseling [23:3]. Hospice is an autonomous option for patients who have a terminal prognosis, and it respects the patient's goals, values, and priorities, maximizing their best interests during the end-of-life stage [23:5-6]. Hospice care also promotes social justice by focusing on palliation and bereavement counseling [23:7].

CORRECT! 🙂

Explanation: Hospice care can be accessed in the home, long-term care facility, or hospital setting [23:2], and a DNR order is not a requirement for hospice care; the only requirement for Medicare hospice is a prognosis of less than six months of life [23:8]. Continuing aggressive treatment is unlikely to be effective and may cause more harm than benefit, especially considering Mrs. Thompson's advanced age and declining condition [23:5]. The correct answer is that hospice care will provide Mrs. Thompson with the opportunity to freely choose quality of life measures that are in line with the medical standards of care, and to die in the presence of family, friends, and loved ones [23:5]. Hospice is an autonomous option for patients who have a terminal prognosis, and it respects the patient's goals, values, and priorities, maximizing their best interests during the end-of-life stage [23:5-6]. Hospice care also promotes social justice by focusing on palliation and bereavement counseling [23:7].

Wrong 😕

Explanation: Hospice care can be accessed in the home, long-term care facility, or hospital setting [23:2], and a DNR order is not a requirement for hospice care; the only requirement for Medicare hospice is a prognosis of less than six months of life [23:8]. Continuing aggressive treatment is unlikely to be effective and may cause more harm than benefit, especially considering Mrs. Thompson's advanced age and declining condition [23:5]. The correct answer is that hospice care will provide Mrs. Thompson with the opportunity to freely choose quality of life measures that are in line with the medical standards of care, and to die in the presence of family, friends, and loved ones [23:5]. Hospice is an autonomous option for patients who have a terminal prognosis, and it respects the patient's goals, values, and priorities, maximizing their best interests during the end-of-life stage [23:5-6]. Hospice care also promotes social justice by focusing on palliation and bereavement counseling [23:7].

CORRECT! 🙂

Explanation: Hospice care recognizes the value of the patient's liberty not to pursue ineffective and futile treatments and not to die in isolation, promoting social justice through a fair distribution of benefits and burdens [23:7]. Hospice care offers patients the opportunity to manage their pain and symptoms, receive emotional support, and die in the presence of family and friends, providing comfort and peace during a challenging time [23:7]. Hospice care satisfies the principles of beneficence (do good) and nonmaleficence (do no harm) and attempts to maximize the patient's best interests during the end-of-life stage [23:6]. The other options are incorrect because hospice care can be a beneficial option for patients with a terminal prognosis, as it allows them to focus on the quantity and quality of life, rather than pursuing ineffective and futile treatments [23:6], a DNR order is not a requirement for hospice care; the only requirement for Medicare hospice is a prognosis of less than six months of life [23:8], and hospice care can be accessed in the home, long-term care facility, or hospital setting, and provides not only pain and symptom relief but also psychological and bereavement support [23:2, 23:7].

Wrong 😕

Explanation: Hospice care recognizes the value of the patient's liberty not to pursue ineffective and futile treatments and not to die in isolation, promoting social justice through a fair distribution of benefits and burdens [23:7]. Hospice care offers patients the opportunity to manage their pain and symptoms, receive emotional support, and die in the presence of family and friends, providing comfort and peace during a challenging time [23:7]. Hospice care satisfies the principles of beneficence (do good) and nonmaleficence (do no harm) and attempts to maximize the patient's best interests during the end-of-life stage [23:6]. The other options are incorrect because hospice care can be a beneficial option for patients with a terminal prognosis, as it allows them to focus on the quantity and quality of life, rather than pursuing ineffective and futile treatments [23:6], a DNR order is not a requirement for hospice care; the only requirement for Medicare hospice is a prognosis of less than six months of life [23:8], and hospice care can be accessed in the home, long-term care facility, or hospital setting, and provides not only pain and symptom relief but also psychological and bereavement support [23:2, 23:7].

CORRECT! 🙂

Explanation: Hospice care attempts to focus not only on the quantity of life but also the quality of life, providing patients with multidisciplinary care and support tailored to their individual needs [23:8]. Hospice care offers patients the opportunity to manage their symptoms, receive emotional support, and die in the presence of family and friends, providing comfort and peace during a challenging time [23:8]. Hospice care satisfies the principles of beneficence (do good) and nonmaleficence (do no harm) and attempts to maximize the patient's best interests during the end-of-life stage [23:6]. The other options are incorrect because a DNR order is not a requirement for hospice care as hospice care attempts to focus not only on the quantity of life but also the quality of life [23:8], hospice care can be accessed in the home, long-term care facility, or hospital setting [23:2], and hospice care is not only for patients with cancer as it can be a beneficial option for patients with a terminal prognosis, regardless of the underlying disease or condition [23:6].

Wrong 😕

Explanation: Hospice care attempts to focus not only on the quantity of life but also the quality of life, providing patients with multidisciplinary care and support tailored to their individual needs [23:8]. Hospice care offers patients the opportunity to manage their symptoms, receive emotional support, and die in the presence of family and friends, providing comfort and peace during a challenging time [23:8]. Hospice care satisfies the principles of beneficence (do good) and nonmaleficence (do no harm) and attempts to maximize the patient's best interests during the end-of-life stage [23:6]. The other options are incorrect because a DNR order is not a requirement for hospice care as hospice care attempts to focus not only on the quantity of life but also the quality of life [23:8], hospice care can be accessed in the home, long-term care facility, or hospital setting [23:2], and hospice care is not only for patients with cancer as it can be a beneficial option for patients with a terminal prognosis, regardless of the underlying disease or condition [23:6].