Hospice and Assisted Suicide: The Structure and Process of an Inherent Dilemma

Abstract

The hospice philosophy involves making terminal patients as comfortable as possible, empowering them with control of the time they have left, but neither hastening nor postponing death. The passage of Oregon's Death with Dignity Act in November of 1994, and the failure of the 1997 ballot measure to repeal it, made physician-assisted suicide another option for terminally ill people in that state, and focused increased attention on a conflict seemingly inherent in the hospice philosophy. We conducted interviews with 60 hospice providers, 43 in Oregon and, for comparison, 17 in the northeast, for their responses to this situation. The data reported here reflect some of the social and individual influences that come to bear as hospice providers attempt to resolve their dilemma.

Patient Perspectives of Dignity, Autonomy and Control at the End of Life: Systematic Review and Meta-Ethnography

“…The studies selected had been conducted in the USA [ 24 , 28 , 33 – 37 ], Canada [ 2 , 30 , 38 , 39 ], Sweden [ 40 , 41 ], the UK [ 16 , 42 , 43 ], China [ 44 – 46 ] and Austria [ 17 ]. Fifteen of the 21 studies dealt exclusively with patients [ 2 , 17 , 24 , 28 , 29 , 35 , 37 – 42 , 44 – 46 ], three exclusively with health professionals [ 33 , 34 , 36 ], and three considered the views of patients, health professionals and family members (see Table 2 ) [ 16 , 30 , 43 ].…”

“…In 11 of the studies this loss of functionality was associated with a diminished quality of life, and it was interpreted as a loss of the value of life [ 2 , 17 , 24 , 28 – 30 , 33 , 34 , 42 ]. By contrast, in those cases where patients highlighted an inner dignity linked to personal or spiritual values, a positive sense of dignity was maintained in spite of the loss of autonomy or control [ 30 , 40 , 43 ].…”

“…A view shared by most participants was that their dignity had been diminished by the loss of control over their life and circumstances: physical functioning, pain, suffering and how they would die [ 2 , 3 , 16 , 17 , 24 , 28 – 30 , 33 , 35 , 36 , 38 , 40 , 42 , 45 , 46 ]. For many of these patients, the fact that they were no longer in charge of their own body was experienced as undermining their dignity and as stripping life of its value.…”