End-of-Life Choice, Death with Dignity, Palliative Care and Counseling

Forcing acute care on every dying person is wrongby Sonja


Citing the example of President Obama’s grandmother Madelyn Dunham, Cynthia Yockey at Pajamas Media tackles the often thorny issue of acute care for the dying.


I don’t know why Dunham was told her quality of life would be terrible. Was it really attributed to being bed-bound from the hip fracture if she refused the hip replacement surgery or becoming cachectic due to the cancer, or both? Or something else like feeling lonely, abandoned, powerless, and frightened of the future?

Madelyn Dunham was offered the choice of surgery because our medical system still supports the autonomy of the individual to determine their own medical treatment, if they are able to do so. For end-of-life care, this includes the autonomy to decide whether to stay in the acute care system or enter hospice care.

In the acute care system, you continue to receive aggressive treatment to the end of life, regardless of side effects that may shorten your life or make life hard to endure, and when you die heroic measures are used to try to bring you back to life. (For example, CPR is a heroic measure. The EMT or nurse who performs CPR generally breaks the sternum and some ribs in the person receiving it — when the recipient is osteoporotic, all of the ribs may be broken. Survival rates after resuscitation are in the 1.4 to 5 percent range.)

In the hospice care system, your pain and anxiety are managed, appetite stimulants are given if needed, and you receive the food and fluids you enjoy and that your body can handle. The treatments and medications with side effects that you can’t stand and which no longer can save your life are withdrawn — ironically, this is the measure most likely to prolong your life and improve its quality. Also, in hospice care, you can die peacefully without the trauma of heroic measures.

Yockey goes on to write how this issue aligns with conservative values:

Personally, I hope we decide that we should pay whatever it takes to preserve the right of the dying to choose between acute care and hospice care, but bring costs down by improving the hospice care system and doing a much better job of explaining why and when to choose it. This satisfies the requirements of conservatism to protect individual liberty and to reduce the cost of government.

Choice at the end of life is not a conservative issue or a liberal issue. It’s a liberty issue. Yockey’s piece is a good reminder that when it comes to end-of-life choice, there’s much for the usually divided to agree on.