Goldilocks and Mrs. Ilych: A critical look at the "philosophy of hospice"

Cambridge Quarterly of Healthcare Ethics

Volumn 6, Issue 3, 1997, Pages 314-324

  Ackerman, Felicia ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ANALYTICAL APPROACH; ARTICLE; ASSISTED SUICIDE; ATTITUDE TO DEATH; ATTITUDE TO HEALTH; CAREGIVER; DEATH AND EUTHANASIA; FAMILY; HOME CARE; HOSPICE; HUMAN; HUMAN RELATION; MENTAL STRESS; NATIONAL HOSPICE ORGANIZATION; PERSONAL AUTONOMY; PSYCHOLOGICAL ASPECT; RESOURCE ALLOCATION; SOCIAL PSYCHOLOGY; SOCIAL SUPPORT; SOCIOECONOMICS; TERMINAL CARE; UNITED STATES;

ANALYTICAL APPROACH; DEATH AND EUTHANASIA; NATIONAL HOSPICE ORGANIZATION;

ATTITUDE TO DEATH; ATTITUDE TO HEALTH; CAREGIVERS; FAMILY; HOME CARE SERVICES; HOSPICES; HUMANS; PERSONAL AUTONOMY; PROFESSIONAL-FAMILY RELATIONS; RESOURCE ALLOCATION; SOCIAL SUPPORT; SOCIAL VALUES; STRESS, PSYCHOLOGICAL; SUICIDE, ASSISTED; TERMINAL CARE; UNITED STATES; VALUE OF LIFE;

EID: 0031158979     PISSN: 09631801     EISSN: None     Source Type: Journal    
DOI: 10.1017/s096318010000801x     Document Type: Article

References (25)

1. Spiegel D. Compassion is the best medicine. Op-ed, New York Times 1994;January 10.
2. See also Ackerman F. Letter to the Editor New York Times 1994;January 25 for criticism of this view.
3. Shavelson L. What the dying really need. Op-ed, New York Times 1996;March 8.
4. Goldberg V. Looking straight into the eyes of the dying. New York Times 1996;March 31.
5. See note 4. Goldberg 1996.
6. See note 4. Goldberg 1996. As I argue in my letter to the editor (New York Times 1996;April 27), this illustrates the media's tendency to put forth the 'hospices are good; high-tech care for the dying is bad' line with about as much sophistication as the "four legs good, two legs bad" motto of Orwell's Animal Farm.
7. The criticisms that do occur are generally from advocates of assisted suicide, who stress the limitations of comfort care and thus do not "argue with the powerful message" quoted above. For example, see Quill T. Death and Dignity. New York: W.W. Norton and Co, 1993:76-97.
8. These principles come from Manard B, Perrone C. Hospice Care: An Introduction and Review of the Evidence. Arlington, VA: National Hospice Organization, 1994:4. The term 'philosophy of hospice' is theirs. I have divided their first principle into my first two and changed the order of some of the other principles to reflect the order in which I discuss them. Also, I have added some material from a list of National Hospice Organization standards for hospice care in Outerbridge D, Hersh A. Easing the Passage. New York: Harper Collins, 1991:109-10 to my Principle 5 and some material from statements by hospice staff in the Home Box Office documentary, Letting Go: A Hospice Journey, which is distributed by the National Hospice Organization, to my Principle 1.
9. These principles come from Manard B, Perrone C. Hospice Care: An Introduction and Review of the Evidence. Arlington, VA: National Hospice Organization, 1994:4. The term 'philosophy of hospice' is theirs. I have divided their first principle into my first two and changed the order of some of the other principles to reflect the order in which I discuss them. Also, I have added some material from a list of National Hospice Organization standards for hospice care in Outerbridge D, Hersh A. Easing the Passage. New York: Harper Collins, 1991:109-10 to my Principle 5 and some material from statements by hospice staff in the Home Box Office documentary, Letting Go: A Hospice Journey, which is distributed by the National Hospice Organization, to my Principle 1.
10. These principles come from Manard B, Perrone C. Hospice Care: An Introduction and Review of the Evidence. Arlington, VA: National Hospice Organization, 1994:4. The term 'philosophy of hospice' is theirs. I have divided their first principle into my first two and changed the order of some of the other principles to reflect the order in which I discuss them. Also, I have added some material from a list of National Hospice Organization standards for hospice care in Outerbridge D, Hersh A. Easing the Passage. New York: Harper Collins, 1991:109-10 to my Principle 5 and some material from statements by hospice staff in the Home Box Office documentary, Letting Go: A Hospice Journey, which is distributed by the National Hospice Organization, to my Principle 1.
11. "The National Hospice Organization makes a distinction between a terminal disease - a disease which ultimately leads to death-something we will all encounter at some point, and a terminal illness, which is a physician's prognosis of impending death. The NHO adds a prognosis of death within six months to its working definition of eligibility." See note 8. Outerbridge, Hersch 1991:107-8.
12. See Bernardin J. Death as a friend. New York Times Magazine 1996;December 1:112-5.
13. These are the words of hospice medical director Dr. Fred Schwartz in Letting Go: A Hospice Journey. See note 8.
14. See note 10. Bernardin 1996:114.
15. The phrase comes from Nagel T. Death. In: Nagel T. Mortal Questions. New York: Cambridge University Press, 1979:1.
16. National Hospice Organization. About hospice. Arlington, VA: National Hospice Organization, 1996:5.
17. See Ackerman F. No, thanks, I don't want to die with dignity. Op-ed, Providence Journal-Bulletin 1990;May 19.
18. See Ackerman F. Buddies. Commentary 1994;December:54. Note also that disbelief in an afterlife is not even necessary for a rational fear of death. Even believers in an afterlife may rationally fear death, for example, because they do not want to leave their familiar lives and loved ones, because they fear a bad fate in the afterlife, or because their belief in the afterlife is shaky, rather than being as strong and unswerving as Cardinal Bernardin's.
19. Nuland S. How We Die. New York: Knopf, 1994:58.
20. It is even more problematic to follow Nuland in expecting such unilateral self-abnegation to be a basis for policy decisions and in using censorious terms like 'vanity' for terminally ill or old people who strive to extend their lives, but not for healthy young people who resent the old for "encroaching" on the "careers and resources" of the young. See note 17. Nuland 1994:86-7 , as well as Ackerman F. No exit. The American Scholar 1995;64(1):131-2 and 134-5. Nuland's book is part of a growing literature that holds that the old and/or terminally ill should be willing to sacrifice their interests in high-tech life-prolongation or last-ditch attempts at cure in order to further (what the authors take to be) the common good. For additional examples of this kind of thinking, see Callahan D. Setting Limits. New York: Simon and Schuster, 1987, and Callahan D. What Kind of Life. New York: Simon and Schuster, 1990. I argue against this sort of view in Ackerman F. What is the proper role for charity in healthcare? Cambridge Quarterly of Healthcare Ethics 1996;5:428. See also note 15. Ackerman 1990; note 18. Ackerman 1995.
21. It is even more problematic to follow Nuland in expecting such unilateral self-abnegation to be a basis for policy decisions and in using censorious terms like 'vanity' for terminally ill or old people who strive to extend their lives, but not for healthy young people who resent the old for "encroaching" on the "careers and resources" of the young. See note 17. Nuland 1994:86-7 , as well as Ackerman F. No exit. The American Scholar 1995;64(1):131-2 and 134-5. Nuland's book is part of a growing literature that holds that the old and/or terminally ill should be willing to sacrifice their interests in high-tech life-prolongation or last-ditch attempts at cure in order to further (what the authors take to be) the common good. For additional examples of this kind of thinking, see Callahan D. Setting Limits. New York: Simon and Schuster, 1987, and Callahan D. What Kind of Life. New York: Simon and Schuster, 1990. I argue against this sort of view in Ackerman F. What is the proper role for charity in healthcare? Cambridge Quarterly of Healthcare Ethics 1996;5:428. See also note 15. Ackerman 1990; note 18. Ackerman 1995.
22. It is even more problematic to follow Nuland in expecting such unilateral self-abnegation to be a basis for policy decisions and in using censorious terms like 'vanity' for terminally ill or old people who strive to extend their lives, but not for healthy young people who resent the old for "encroaching" on the "careers and resources" of the young. See note 17. Nuland 1994:86-7 , as well as Ackerman F. No exit. The American Scholar 1995;64(1):131-2 and 134-5. Nuland's book is part of a growing literature that holds that the old and/or terminally ill should be willing to sacrifice their interests in high-tech life-prolongation or last-ditch attempts at cure in order to further (what the authors take to be) the common good. For additional examples of this kind of thinking, see Callahan D. Setting Limits. New York: Simon and Schuster, 1987, and Callahan D. What Kind of Life. New York: Simon and Schuster, 1990. I argue against this sort of view in Ackerman F. What is the proper role for charity in healthcare? Cambridge Quarterly of Healthcare Ethics 1996;5:428. See also note 15. Ackerman 1990; note 18. Ackerman 1995.
23. It is even more problematic to follow Nuland in expecting such unilateral self-abnegation to be a basis for policy decisions and in using censorious terms like 'vanity' for terminally ill or old people who strive to extend their lives, but not for healthy young people who resent the old for "encroaching" on the "careers and resources" of the young. See note 17. Nuland 1994:86-7 , as well as Ackerman F. No exit. The American Scholar 1995;64(1):131-2 and 134-5. Nuland's book is part of a growing literature that holds that the old and/or terminally ill should be willing to sacrifice their interests in high-tech life-prolongation or last-ditch attempts at cure in order to further (what the authors take to be) the common good. For additional examples of this kind of thinking, see Callahan D. Setting Limits. New York: Simon and Schuster, 1987, and Callahan D. What Kind of Life. New York: Simon and Schuster, 1990. I argue against this sort of view in Ackerman F. What is the proper role for charity in healthcare? Cambridge Quarterly of Healthcare Ethics 1996;5:428. See also note 15. Ackerman 1990; note 18. Ackerman 1995.
24. See note 13. Nagel 1979:10.
25. See note 8. Outerbridge, Hersh 1991:107.