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 Patient: Autonomy

 Practitioner: Beneficence & Nonmaleficence

 Public Policy: Justice


23c*. Hospice

[C23:1] A patient with end-stage lung cancer is admitted to the hospital. The patient refuses to have a do-not-attempt-resuscitation (DNAR) order but also requests that no heroic measures be performed. Which of the following conditions are necessary conditions for hospice consideration?


  • A. Must have a do-not-resuscitate for hospice.
  • B. Must be admitted to a healthcare institution.
  • C. Must have decision-making capacity.
  • D. Must have a terminal prognosis of six months or less.
  • E. All of the above.


TAC: Think - Assess - Conclude

I. Think: What is the question?

[C23:3] What are the hospice requirements?

II. Assess: Specify & Balance the four principles of bioethics

Patient: 1) Autonomy - Informed Consent

[C23:4] The patient has the individual moral obligation and the legal right to consent, refuse, or withdraw from any medical treatments, including hospice. If the patient loses decisional capacity and cannot provide oral or written consent, then the following in order or authority must be used to determine the patient’s wishes: living will, durable power of attorney, and surrogate(s). A living will present in writing what the patient’s wishes are, medical power of attorney determines whom the patient has given authority to make medical decisions for the patient if and when the patient loses decisional capacity, and lastly is the surrogate checklist in order of authority: 1) guardian, 2) spouse, 3) adult offspring, 4) either parent, 5) adult sibling, 6) adult grandchild, 7) adult friend, 8) guardian of the estate, 9) temporary custodian. The assumption is that the closer the surrogate’s relationship with the patient, the better able the surrogate will exercise substituted judgment, meaning making medical decisions as if they were the patient by using the patient’s reasonable goals, values, and priorities.

Practitioner: 2) Beneficence & 3) Nonmaleficence

[C23:5] Professional beneficence (do good) and professional nonmaleficence (do no harm) are the driving force towards the making of hospice available for patients who have a terminal prognosis of less than or equal to six months to live. Nonmaleficence is manifested by not subjecting the patient to futile and harmful procedures. Beneficence is manifested by providing compassionate care that focuses on comfort and quality of life, including comfort measures such as the control of pain and bereavement counseling for both the patient and the patient’s family.

Public Policy: 4) Justice

[C23:6] The state has an obligation to promote the fair distribution of benefits and burdens. Hospice is the recognition of the dignity of its citizens in being able to live their last months of life with as much quality of life as possible, physically and psychologically.


III. Conclude: Nationally or Professionally True Answer

[C23:8] Hospice requires a terminal prognosis of six months or less.

Answer Options: [C23:9]

(Choice A) Must have a do-not-resuscitate for hospice.

A is the wrong answer. Although most patients in hospice care have directives to decline heroic life-sustaining measures, a do-not-resuscitate order is not a prerequisite for receiving hospice services.

(Choice B) Must be admitted to a healthcare institution.

B is the wrong answer. Hospice is not location-specific. Hospice can be at a hospice facility, nursing home, assisted living, or home.

(Choice C) Must have decision-making capacity.

C is the wrong answer. Hospice can be a decision made by the patient, and if the patient does not have decisional capacity, it can also be made by a living will, a durable power of attorney, or the patient’s surrogate(s).

(Choice D) Must have a terminal prognosis of six months or less.

D is the correct answer. The main requirement for hospice is a terminal prognosis of six months or less. Although futile treatment will not be performed in hospice, all other treatment that the patient or surrogate wishes to have will be administered or continued. The focus is on quality of life and symptoms reduction.

(Choice E) All of the above.

E is the wrong answer. Because A, B & C are not correct answers