Hospice Care in The United States - Philosophy and Practices

Philosophy and Practices

The goal of all hospice agencies in the United States is to provide comfort to the patient. How comfort is defined is up to the patient or, if the patient is incapacitated, the patient's family. This can mean freedom from physical, emotional, spiritual and/or social pain. Hospices typically do not perform treatments that are meant to diagnose or cure an illness, and they do not seek to hasten death or, primarily or unduly, to extend life. While it is not required that patients sign "Do not resuscitate" orders to be on hospice, some hospices do require them as a condition of acceptance. Many hospice patients, though not all, have made decisions not to receive CPR should their heart or breathing stop. If a patient does decide to request CPR, that service may not be provided by the hospice; the family may need to contact Emergency Medical Services to provide CPR. The decision not to extend life as well as the pulling back of diagnostic or curative treatments is often the greatest barrier for patients in accepting hospice care; it can also create conflicts in medical professionals attempting to provide it.

Some confusion exists as to what treatments a patient may receive and still qualify for hospice care. Hospices may provide treatments that have been traditionally regarded as curative, including radiation therapy or antibiotics, if these are administered to improve quality of life. Determination of appropriate treatment is made on a case-by-case basis.

Another aspect of the hospice philosophy is the patient-centered care they provide. As the focus throughout the United States has shifted from provider-centered care, many healthcare agencies market themselves as patient-centered; for hospice, this patient-directed care is integral and interwoven throughout the care which is provided, and Medicare regulations reflect this philosophy.