Hospice ethics presentation


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Hospice ethics presentation

  1. 1. Ethical Issues of Hospice and the Loss of Technology
  2. 2. <ul><li>Hospice remains committed to providing care that treats the person, not the disease, and emphasizes quality of life, not duration. </li></ul>
  3. 3. What is Hospice? <ul><li>Follows palliative care philosophy </li></ul><ul><ul><ul><li>Goal is in reducing severity of disease symptoms rather than providing a cure </li></ul></ul></ul><ul><ul><ul><li>Offers comfort and dignity to patient dealing with illness </li></ul></ul></ul><ul><ul><ul><li>Treats the patient holistically: physically, spiritually, and emotionally. </li></ul></ul></ul><ul><ul><ul><li>Reaches out to families and caregivers to provide support </li></ul></ul></ul>
  4. 4. Hospice.. As Told by Lisa  <ul><li>Heartland requires that you go through 6 hours of training </li></ul><ul><li>Sit with patients for 3 hours a week, most have dementia </li></ul><ul><li>Some are actively dying </li></ul><ul><li>Also go to a home for 3 hours a week and sit with someone in home care </li></ul><ul><li>Main job= LISTEN LISTEN LISTEN!! </li></ul><ul><li>Has helped me personally cope with issues with death as well as being comfortable talking about one’s own death </li></ul>
  5. 5. Sheila <ul><li>Sheila, 55 year old female </li></ul><ul><li>Lupus, Hospice patient </li></ul><ul><li>Famous quotes by Sheila: </li></ul><ul><ul><li>“ Hospice is somewhere I never thought I’d be. Sometimes I sit and wonder why this is happening to me, why I’m only 55 and I feel like I should be at home enjoying my life.” </li></ul></ul><ul><ul><li>“ I just want to go home. The food is terrible here.” </li></ul></ul><ul><ul><li>“ Being in hospice is difficult. You have to come to terms with your own death. You have to face things that you never thought you would have to face so soon. No one comes to visit me, I’m dying alone.”  </li></ul></ul><ul><ul><li>Sheila is the youngest person that I have ever volunteered with </li></ul></ul>
  6. 6. Ethical Issues and Communication
  7. 7. Ethical Issues within the Hospice System <ul><li>As with all end of life care, many ethical issues surround hospice and palliative care </li></ul><ul><li>Ethical issues involve three major areas: </li></ul><ul><li>A respect for patient autonomy </li></ul><ul><ul><ul><ul><li>Ex. artificial nutrition and hydration </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Withdrawing and withholding treatment </li></ul></ul></ul></ul><ul><li>Access to care and overcoming barriers </li></ul>
  8. 8. A Respect for Patient Autonomy <ul><li>Many patients are unresponsive, on life-support </li></ul><ul><li>Artificial hydration and nutrition </li></ul><ul><ul><li>YES or NO? </li></ul></ul><ul><li>What would the patient want? </li></ul><ul><li>Physician-assisted suicide </li></ul><ul><li>Decision-making is very hard </li></ul><ul><ul><li>Lot of uncertainty surrounding it </li></ul></ul>
  9. 9. Barriers and Access to Hospice Care <ul><li>Communication and Language Barriers </li></ul><ul><li>Underutilization by minorities </li></ul><ul><ul><li>84% Caucasians </li></ul></ul><ul><ul><li>8% African Americans </li></ul></ul><ul><ul><li>8% others </li></ul></ul><ul><li>Mistrust within the health care system </li></ul><ul><li>Lack of knowledge </li></ul><ul><li>Lack of minority employees </li></ul>
  10. 10. Demographical Features and Barriers to Access <ul><li>Hospice serves more Caucasian females then any other race or sex </li></ul><ul><li>African Americans and Hispanics have been shown to receive less care through Hospice </li></ul><ul><li>Middle to lower class seek care through hospice </li></ul><ul><li>“ Identifying and overcoming these barriers is important in improving access to end of life care now and will become even more critical in coming years,” (Hastings Center Report 1). </li></ul><ul><li>“ Misperceptions caused by lack of cultural sensitivity and skills can lead to unwanted or inappropriate clinical outcomes and poor interaction with patients and their families at critical junctures as life comes to a close”. </li></ul><ul><li>Research has shown that African Americans and Hispanics receive less pain medication then Caucasians </li></ul>
  11. 11. Lack of Information about Hospice Services <ul><li>In 2004: </li></ul><ul><ul><li>African Americans represented fewer than 10% of the nearly 1 million Americans who utilized hospice care (NHPCO, 2004). </li></ul></ul><ul><ul><li>Another study evaluated more than 1500 deaths in which 111 decedents were African American and asked families of non-hospice users if hospice had been offered as an option. These investigators found that 68% of the African Americans had not used hospice services, and of these, more than half had not been informed about the availability of hospice (Abdul-Malik et. al., 2004). </li></ul></ul>
  12. 12. Hospice and How Communication is Lost Through Technology
  13. 13. COMPUTERS! <ul><ul><li>No human intervention </li></ul></ul><ul><ul><ul><li>Everything is done through/on the computer </li></ul></ul></ul><ul><li>No one talks to each other </li></ul><ul><li>Instead of having conversations with the staff people watch TV </li></ul><ul><li>Loss of communication due to technology is very apparent </li></ul>
  14. 14. Computers… Good or Bad?
  15. 15. Hot or Not? <ul><li>Positives </li></ul><ul><ul><li>Everything kept in a file on the computer and this is organized </li></ul></ul><ul><ul><li>Easier then writing it down </li></ul></ul><ul><ul><li>Easier to read then some of the doctor’s handwriting </li></ul></ul><ul><li>Negatives </li></ul><ul><ul><li>It’s a strong subculture </li></ul></ul><ul><ul><li>Ethical issue because people leave files up and that’s a confidentiality issue </li></ul></ul><ul><ul><li>Loss of transfer by human hand/word of mouth </li></ul></ul>
  16. 16. Implications for the Future <ul><li>More community involvement </li></ul><ul><ul><li>Hospice promotion: especially targeting minority populations </li></ul></ul><ul><ul><li>Education of the wide array of services offered by hospice </li></ul></ul><ul><ul><li>Address misconceptions and issues of mistrust </li></ul></ul>
  17. 17. Thank You for Your Time 