Palliative Care

Prepared by Julie Grimstad, Patient Advocate

 

Opposition to legislation (like Wisconsin Assembly Bill 633) which would establish a Palliative Care Advisory Council to promote palliative care (PC) is not opposition to good pain management and medical treatment. Relieving pain and other bothersome symptoms of disease are ordinarily good things to do. However, PC medicine in practice often is not as advertised.

 

The ‘Tools’ of Palliative Care Medicine Can Be and Are Used to Hasten Death

 

Dr. Ralph A. Capone, who is board-certified in Hospice and Palliative Care Medicine and Internal Medicine, writes,

According to the new bioethics, when applied to certain people, “do no harm” implies further life is harmful and, therefore, killing them is beneficent. In hospice and palliative care settings, the administration of intentionally larger doses of analgesia, beyond that necessary to diminish pain, is sometimes done to intentionally end patients’ lives. This is not a secret within the medical profession. [Emphasis in the original.] [1]

 

Human Life Alliance and its committee, the Pro-life Healthcare Alliance, as well as other organizations (e.g., Hospice Patients Alliance, Terri Schiavo Life and Hope Network, Life Legal Defense Foundation), cite numerous tragic cases of people who have sought our help when a loved one was being overdosed with analgesics and sedatives and denied basic care or when a loved one’s death was hastened in a PC setting without the family realizing what was happening at the time. Consequently, we are hard-pressed to know which hospice and palliative care programs can be trusted to care for and not kill the patients entrusted to them. We, who are involved in protecting patient’s lives every day, are very concerned that PC medicine has become an agent of death in many cases.

 

Dr. Farr A. Curlin, a Palliative Medicine Specialist at Duke University, validates our concerns:

Many patients and their families don’t trust HPM and are resistant to it. I encounter such individuals in the hospital and in the community, among people of all walks of life and social strata but particularly among ethnic minorities and members of religious communities. These individuals tell stories about loved ones who declined slowly over time, fighting the good fight with the support and companionship of their family members and friends. When HPM professionals became involved in their care, their loved ones were put on powerful drugs, became unconscious and unresponsive, and were soon dead. These stories are clearly shared within communities and powerfully shape people’s perceptions of HPM, which many see as a sophisticated and seductive way of getting people to die. In fear that HPM will usurp the role of the patient and that of the community in dying well, these people choose to go without the palliation that could help the patient participate in dying well. [2]

 

Dr. Curlin warns, “When the goal of HPM shifts from helping patients who are dying to helping patients die, practices that render patients unconscious or hasten their death no longer seem to be last-resort options.” [Emphasis added.] [3]

 

“Stealth Euthanasia” in Hospice and Palliative Care Settings

 

Some PC providers intentionally kill patients under false pretenses. “Stealth euthanasia” is a term used to describe the intentional hastening of a patient’s death while pretending to provide appropriate treatment. (The deliberate ending of a patient’s life can be covered up easily by claiming a pure intention to ease pain and suffering.) Usually we hear of such a case from a family member who contacts us after the patient has died in a hospice and palliative care setting. For example, after describing her father’s cruel and untimely death, Heidi Wise wrote,

I have done a lot of research and have come to understand that “stealth euthanasia” is a widespread problem and a deeply troubling trend. For example, an indictment was recently handed down for sixteen people who were overdosing patients at a hospice in Texas. In some cases the overdoses led to death. [4] … In just one month, three of my friends told me that they have had similar horrifying experiences. Even people I don’t know have reached out to me on Facebook to tell me about their loved ones who they believe were killed by health care providers. Just like me, they are traumatized and extremely distressed.” [5]

 

A Cost-Containment Strategy

 

Any cost savings are most likely due to reducing or stopping curative and life-sustaining treatment and even withdrawing basic care such as the provision of nutrition and hydration. Palliative care is not focused on treatment for medical conditions. PC (pain and symptom relief), of itself, does not reduce costs.

 

PC is exploited to limit treatment and/or cause death as a cost-containment strategy.
Dr. Timothy E. Quill, President of the American Academy of Hospice and Palliative Medicine (AAHPM), in 2012, stated,

There is growing consensus that one of the biggest challenges of healthcare reform is the costs attributable to the sickest patients-especially the costs attributable to treatments of no or marginal benefit. This is why our demonstrated ability to improve quality of life, assist with difficult decision making, and decrease the overall costs of patient care make palliative care an obvious inclusion in the healthcare reform bill.” [6]

 

Dr. Quill may have a very different view of what constitutes treatment “of no or marginal benefit” than a patient, family or treating physician has. Our experience has been that many PC providers deem “allowing” patients to die to be compassionate and cost-efficient.

 

Also, PC specialists do not focus on treating patients’ underlying medical conditions, but only on treating symptoms which cause distress, yet Dr. Quill notes that they “assist with difficult decision making.” How can they discuss treatment options with patients when they are not the ones who provide treatment for patients’ diseases and other life-threatening conditions?

 

Many Palliative Care Leaders Are Comfortable With Killing

 

Dr. Quill (cited above) is not only a leader in the palliative care movement, he is also a board member of the Death with Dignity National Center which promotes the legalization of assisted suicide throughout the United States. In 1991, he wrote in the New England Journal of Medicine about providing a lethal dose of drugs to his patient, Diane. In 1997, Dr. Quill was the respondent in the U.S. Supreme Court case Vacco v. Quill challenging the ban on assisted suicide in New York. He argued that there is no difference between refusing lifesaving medical treatment and assisted suicide. In 2017, Dr. Quill again sought to overturn New York’s law against assisted suicide as a plaintiff in Myers v. Schneiderman. It is important to note that Dr. Quill is very much in the mainstream of the mindset of Hospice and Palliative Medicine. In 2013, he was celebrated by his peers as one of several “Hospice and Palliative Medicine Visionaries.”

 

The National Hospice and Palliative Care Organization (NHPCO) is the largest organization representing Hospice and Palliative Care programs and professionals in the United States. “The NHPCOis the actual legal and corporate successor to the Euthanasia Society of America. [7] The Euthanasia Society of America was successively known as the Society for the Right to Die, Choice in Dying, Partnership for Caring, and Last Acts Partnership before finally being absorbed into the NHPCO. This explains the contradiction between the publicly stated hospice mission and the reality in too many clinical settings. It appears that the NHPCO is intent on quietly subverting that life-affirming mission.” [8]

 

Dr. Quill and Dr. Ira R. Byock, another prominent hospice and palliative care physician, have suggested that terminal sedation (a.k.a. palliative sedation)-making and keeping a patient unconscious until death occurs-and voluntarily stopping eating and drinking (VSED) can “substantially increase patients’ choices at this inherently challenging time.” [9]

 

When leaders in Hospice and Palliative Medicine are comfortable with killing, is palliative care safe for patients?

 

A Foot in the Door for Legalization of Assisted Suicide

 

The 2016 International Association for Hospice and Palliative Care Position Statement on Euthanasia and Physician-Assisted Suicide declares,

The IAHPC believes that no country or state should consider the legalization of euthanasia or PAS [physician-assisted suicide] until it ensures universal access to palliative care services and to appropriate medications, including opioids for pain and dyspnea. [10]

 

The IAHPC does not oppose euthanasia and PAS. Note the word “until.” We hear this type of rhetoric repeatedly along with the unproven claim that palliative care reduces requests for assisted suicide and, therefore, once there is universal access to palliative care, it will be “safe” to legalize PAS. Safe, legal suicide? Nonsense!

 

These are just some of the reasons for opposition to legislation promoting PC. For more information: Pro-life Healthcare Alliance, 651-484-1040, www.prolifehealthcare.org.

 

[1]Ralph A. Capone, MD, FACP, “Hospice and Palliative Care Medicine: Is It Losing Its Soul?” Imposed Death: Euthanasia and Assisted Suicide, p.10, https://resources.humanlife.org/pdf/Imposed_Death.pdf

[2]Farr A. Curlin, MD, Hospice and Palliative Medicine’s Attempt at an Art of Dying, ch. 4 in Dying in the Twenty-First Century, p. 48, edited by Lydia Dugdale, MD, MIT Press 2015.

[3]Ibid. p.58.

[4] https://www.dallasnews.com/news/frisco/2017/02/28/frisco-man-15-others-indictedmedicare-hospice-scheme-used-human-life-vulnerable-stage

[5]Heidi Wise, “I Witnessed Involuntary Euthanasia in Hospice,“https://www.prolifehealthcare.org/wp-content/uploads/2017/12/12-06-2017-newsletter.pdf

[6]http://digitaleditions.walsworthprintgroup.com/article/Meet+AAHPM+
President+Timothy+E.+Quill,+MD+FACP+FAAHPM/1010399/105036/article.html

[7] Hospice Patients Alliance, “From Euthanasia Society of Amer­ica to National Hospice & Palliative Care Organization (1938-Present),”  http://www.hospicepatients.org/euthanasia-soc-of-america-to-natl-hosp-and-palliative-care-org.pdf.

[8] Ralph A. Capone, MD, Kenneth R. Stevens, MD, et al, “The Rise of Stealth Euthanasia,” Ethics & Medics, 06/2013, Vol. 38, No. 6, https://www.prolifehealthcare.org/rise-stealth-euthanasia/

[9]Timothy E. Quill and Ira R. Byock, “Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids,” Annals of Internal Medicine 132.5 (March 7, 2000): 408-414.

[10] http://online.liebertpub.com/doi/full/10.1089/jpm.2016.0290?src=recsys&

 

 

PALLIATIVE CARE READING LIST

 

Capone, Ralph A, MD, Kenneth R. Stevens, MD, et al, “The Rise of Stealth Euthanasia,” Ethics & Medics, 06/2013, Vol. 38, No. 6, https://www.prolifehealthcare.org/rise-stealth-euthanasia/ 

 

Curlin, Farr A, MD Hospice and Palliative Medicine’s Attempt at an Art of Dying, ch 4 in Dying in the Twenty-First Century, edited by Lydia Dugdale, MD, MIT Press 2015.

 

Dietz I, Borasio, GD, Med DP, et al, “Errors in palliative care: kinds, causes, and consequences: a pilot survey of Experiences and attitudes of palliative care professionals,” Journal of Palliative Medicine, 2013; 16:74-81.

 

Rousseau, Paul, MD, “The Ethical Validity and Clinical Experience of Palliative Sedation,” Mayo Clin Proc. 2000; 75:1064-1069,

http://www.mayoclinicproceedings.org/article/S0025-6196(11)64426-1/pdf

 

“The Progression of Death Rhetoric in the U.S.A. 1938-2017” (see, in particular, year 2004), Imposed Death: Euthanasia and Assisted Suicide, edited by Julie Grimstad, Human Life Alliance,https://resources.humanlife.org/pdf/Imposed_Death.pdf 

 

How the Culture of Death Was Brought to American Medicine (see, in particular, years 2000 to 2004),

http://lifetree.org/timeline/EOLchronology.pdf