I have no qualms about the decision of an individual to opt for an alternative to traditional medicine and choose to end their life early and with dignity. After all, the hospice movement was also born as an alternative to the medical establishment, and also ushered in right-to-choose preferences for end-of-life care.
I just hope that people deciding to self-administer a lethal dose of medication have considered all the options, including hospice care. At life’s end, hospice can provide comprehensive, pain-free and humane care with meaning and more moments with loved ones.
I also hope that legislators debating a “death with dignity” bill that was introduced last week consider hospice as an option that is underutilized in California.
Our society has traditionally treated aging, frailty and death as a clinical problem. Because we live in a death-defying, death-denying country, we have a medical system where the inevitable outcome of death is frequently prolonged through futile treatments and “heroic” measures. Doctors, taught to treat disease, are often uncomfortable with what they see as admitting defeat and recommending less invasive, more compassionate care.
It is unfortunate, despite the tremendous growth and availability of hospice, that an awareness vacuum exists. Some people experiencing an emotional crisis after receiving a dire prognosis are unaware that hospice is available through Medicare and other health insurance providers – and, in the case of not-for-profit hospice, free and available to almost everyone. Now, only 32 percent of Californians die at home even though the vast majority say they would prefer to be cared for at home.
As the 78 million baby boomers – a generation not known for aging gracefully – go through the overburdened health care system in the coming decades, Medicare will spend more than Homeland Security or Education on end-of-life care that is often painful and does little to support quality of life.
Not to complicate matters, but just as there is disparity in medical care, all hospice providers are not the same. There has been recent criticism that some are shortchanging their patients. It matters which hospice you choose, and yes, patients do have choice.
There will be a day soon when hospice providers are rated, and consumers will be able to ensure that they or their loved ones are getting the support services they are entitled to. There will also come a day when society sees death and dying as a natural, beautiful moment in life, making grief for those left behind less painful.
With a chosen hospice provider keeping its promise and providing the support and care to its patients, the reasons to choose “death with dignity” – fearing severe pain, being a financial burden or just being lonely – would be off the table.
I hope those who find themselves in a situation like Brittany Maynard give it a try.
Michael Schmidt is executive director of Snowline Hospice and Supportive Care, a nonprofit provider in the Sacramento region.