Hospital death is typically more impersonal than death under hospice care. Medical schools teach a professional persona that leads to distancing from patients. Medical students learn to use precise medical terms that often leave patients and families confused about diagnoses, treatment, symptoms, and even what the illness might actually be. It is not that physicians cannot care effectively for the dying and their families, but rather that the system is not designed to allow them to have the time and setting to offer the level of compassionate care that hospice can provide. Living until you die is a goal of hospice. Healing and delaying death is the goal of hospitals. Yet people most often die in hospitals.

Staying at home is typically less expensive than being cared for in a hospital. Often programs exist to enhance in-home care, by providing equipment, medicine, meals, and other needs at little or no cost to the dying or their families. Although nurses may be expensive, treatment is still cheaper at home than in hospitals. For most families, economics is not the issue but rather the ability of family members and the staff who assist them to provide quality care, pain management, and a good quality of life and still maintain their own lives, jobs, and quality of life. End-of-life care is demanding and includes limiting the length and numbers of visitors for the terminally ill person, managing neighborhood noise, helping the ill person negotiate stairs, bathing, changing catheters, dealing with emotional outbursts and the person's fear of the caregiver leaving to go shopping or do other required errands, and avoiding family disagreements. Consequently, despite the costs, some family members would prefer not to have the person die at home. Also, hospitals may make families more secure in their belief that they did everything possible for the dying person.

Most families want to care for their dying, but many are not physically, financially, spiritually, or emotionally able to aid the dying. While physicians first seemed to avoid hospice and perhaps saw it as a failure on their part, now most physicians seem to have embraced the approach. Hospice has even had an impact on hospitals, where death is not as impersonal and bureaucratic as it once was. The growth of medical ethics, advanced directives, palliative care, and bereavement services in hospitals is evidence of the impact of hospice, which stretches far beyond the dying.

Bibliography:

1) Connor, Stephen R. 1998. Hospice: Pitfalls, and Promise. Bristol, PA: Taylor & Francis.

2) Saunders, Cicely M. and Robert Kastenbaum. 1997. Hospice Care on the International Scene. New York: Springer.

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