Hospice care.

"Birth and death are the most singular events we experience and therefore the contemplation of death as of birth should be a thing of beauty." The hospice movement emerged out of an awareness that the needs of the dying patient were not being adequately met by the modern medical establishment. It has brought about a positive change in attitudes toward the dying. Hospice has given the patient and family back the responsibility of making decisions regarding life and death. It has called to our awareness difficult moral and ethical issues to which no clear right or wrong answers exist but about which only informed judgments may be made. However, the hospice program has a long way to go. The public needs to be educated about existing financial, social, and medical provisions available to them in preparation for death. The education of medical, nursing, and paramedical professionals must emphasize technical and philosophical principles about death and dying. Teachers must address moral and ethical issues, and physicians must demonstrate kind and compassionate care in the management of their dying patients. Finally, society has the moral obligation to ensure that its dying members have access to care directed specifically to their needs. Hospice does not offer simple solutions to all the problems raised in this article, but it does embody a philosophy of care that acknowledges these issues, and it provides support for those with the courage to address them. Hospice care in the United States is now at a crossroads; whereas such care is appealing and acceptable to the public, this care has yet to find its place as an integral part of the health care system and be accepted as another facet of health delivery.

Attitudes of house officers toward a hospice on a medical service.

A hospice program (HP) was established on the medical service at the Denver Veterans Administration Medical Center (DVAMC) for the care of the terminally ill cancer patients and to integrate such care into house staff training. A two-bed inpatient unit was managed by an intern, a resident, and the attending physician with the aid of a multidisciplinary team. During the program's first year, 29 patients were cared for with an average inpatient stay of 26 days. Twenty-nine out of a possible 33 house officers returned questionnaires evaluating their hospice experience. Twenty-eight respondents felt that the hospice program was appropriate in a teaching hospital. Over half indicated improved awareness of the psychological problems of their patients and families. Two-thirds of the house staff members felt that the HP changed their approach to pain control and made them more comfortable in dealing with terminally ill patients. From this study, it can be concluded that a hospice program can be successfully integrated into an active medical teaching service.