Session 17: What About Hospice and Palliative Care?
Notes
Transcript
(Intro Music starts with first slide - read intro and move forward)
Welcome to Apologetics and the Gospel. My name is Pastor Jonathan White, and I am the Lead Pastor at CrossPointe Family Church in Winfield, WV as well as a practicing Emergency Medicine Physician.
Question for Today: What About Hospice and Palliative Care?
Question for Today: What About Hospice and Palliative Care?
Last session we discussed physician assisted suicide - also known as euthanasia. This hot button issue was addressed through both scientific data and the Scriptures and found to be in opposition of God’s commands. But we noted that the heart behind why people seek legalization of euthanasia is often because of desiring mercy and peace for those suffering.
So what about hospice and palliative care? Are these valid options for those who are suffering?
Let’s dive in and seek to understand what these two branches of medicine actually are.
Hospice
Hospice
Hospice is a program of care for terminally ill patients that seeks to palliate symptoms by treating symptoms rather than an incurable disease process. It is provided for those who are deemed by a physician to have six months or less to live in light of their current illness.
Good hospice care focuses on physical, mental, and spiritual wellbeing. Good hospice care also focuses on family dynamics and relationships as well. Many hospice organizations even provide family support groups.
There comes a time in healthcare where doctors are unable to cure or adequately treat a disease process. These patients are referred to hospice for what is often referred to as comfort or mercy care. The focus of doctors in hospice care is on the symptoms that the patient is experiencing and not the underlying disease process itself.
Next we come to…
Palliative Care
Palliative Care
Palliative care is a field of medical care that addresses those with serious medical conditions as well. It is meant to enhance a person’s current care by focusing on quality of life for them and their family. Whereas palliative care is always a part of hospice care, those on palliative care may not necessarily qualify for hospice care which requires one to have a life expectancy of 6 months or less.
How Common is Hospice Care Utilized?
How Common is Hospice Care Utilized?
According to data from 2019:
According to Medicare data, 51.6% of those insured by Medicare were enrolled in hospice at the time of death.
The average Lifelong Length of Stay for Medicare patients was 92.6 days.
With this much utilization we have seen 4,840 Medicare-certified hospices that are operational as of 2019.
(https://www.nhpco.org/nhpcos-new-facts-and-figures-report-shows-changes-in-hospice-patient-diagnoses/)
Unfortunately, many patients do not receive hospice care until late in their disease processes. 25% of patients did not receive care until the last 5 days of life while 10% were not until the last 2 days of life.
This shows a need for more education on earlier hospice referrals for mercy care.
As an ER doctor, I commonly see people struggle with the idea of hospice. They often feel like hospice means they are giving up. Yet, it is important for us to know that just because we can do something doesn’t mean we should. We face many ethical and moral challenges with modern medicine.
Medicine has advanced greatly over the past few decades. We now have decisions before us that generations ago never had to face. Consider life-support measures such as ventilators.
We can put people on ventilators to keep them alive for a while. Yet, if they are an end-stage lung cancer patient or an end-stage COPD patient, the odds of them coming off of the ventilator are very low. Once we go through with intubating the patient and placing them on a ventilator, the family now must consider the heart-wrenching decision to “pull-the-plug.” This is an unfortunate situation that could have been averted if the family would have been educated on the situation better and would have discussed these end-life situations with their loved one more thoroughly before this even occured.
This is where hospice care shines. It is not giving up. It is accepting that everyone will die eventually. And it is doing our best to allow people to die with dignity and comfort.
Before getting into the Scripture, there is one other ethical dilemma that concerns some people.
Does Hospice Speed up the Dying Process?
Does Hospice Speed up the Dying Process?
This is another ethical and moral question that we must answer. The short answer is that this is frankly a tough question. It is next to impossible - not to mention unethical - to randomize two groups of people and provide mercy care to one group and no care at all to the other as they suffer at the end of life.
If medications are given on an as-needed basis along with a reasonably modest scheduled dosing then the answer should be no to this question.
Only if a provider or nurse is giving far more than recommended doses should these medications speed up the dying process.
Taking this question from a different angle - not treating the underlying disease process such as cancer or invasive infections may or may not lead to a quicker death. This situation is debatable and has many factors that go into it.
For example, one could argue that some cancer patients die from chemotherapy side effects and/or invasive infections because of being on chemo and so in some cases, withholding treatment may even extend one’s life if it is an incurable cancer type.
Situations such as these should be individualized with patients, families, pastoral staff, and physicians discussing the details before making any final decisions.
Moving forward, we need to ask ourselves…
What does the Bible Say?
What does the Bible Say?
There are a few verses we can address here as we go through this difficult subject.
First, as we discussed last week, God does not permit euthanasia or physician-assisted suicide. We are not to intentionally kill another person. We are made in the image of God. See last week’s session for verses and teaching on that subject.
Next, we see that we should share burdens. End of life care can be very difficult, and we need to have help during this difficult time.
Galatians 6:2 says:
Bear one another’s burdens, and so fulfill the law of Christ.
We need to be there for one another as the church body. And we need to allow our friends at hospice care to be there for us and our loved ones during end of life care. Ideally, finding a hospice organization that is Christian-based is the best case scenario.
Secondly, we need to embrace the fact that death is not the end. We are not giving up by accepting a hospice referral. We are embracing our transition from this body of death to eternal life.
But we do not want you to be uninformed, brothers, about those who are asleep, that you may not grieve as others do who have no hope.
We do not need to grieve as those without hope. We know that those who die are immediately in the presence of the Lord (see 2 Corinthians 5:8)!
Yes, we are of good courage, and we would rather be away from the body and at home with the Lord.
Thirdly, we need not fear death.
for God gave us a spirit not of fear but of power and love and self-control.
We should not fear death. Fear is the opposite of faith. Do we not believe Jesus when He said He went to prepare a place for us (John 14:3)?
We should look forward to meeting our Savior face-to-face one day. Yes, the dying process can feel scary for many, but the overwhelming joy of what is to come must overshadow the fear of the dying process for us. Allow the peace and love of God to cast out your fear.
And finally, we should value eternal life more than this earthly life. I am afraid that many of us have spent so much time trying to create heaven on earth that we are missing out on the excitement heaven has to offer. We have continued to think less and less of God and His promises and more and more about what we see in front of us.
The Apostle Paul understood what was to come well. And he understood the trials and hardships that can come in the lives of true believers on earth also.
Three times I was beaten with rods. Once I was stoned. Three times I was shipwrecked; a night and a day I was adrift at sea; on frequent journeys, in danger from rivers, danger from robbers, danger from my own people, danger from Gentiles, danger in the city, danger in the wilderness, danger at sea, danger from false brothers; in toil and hardship, through many a sleepless night, in hunger and thirst, often without food, in cold and exposure.
Paul understood the difficulties of this life much more than most of us do. But because of this, he knew what was to come was much better than what is present. That is why he can confidently say:
For to me to live is Christ, and to die is gain.
There was a promised gain (namely heaven) that he looked forward to that would be received upon his death.
And for those in Christ, we can all look forward to that immeasurable gain upon the death of these mortal bodies. Praise the Lord for that!
So in essence, we see that we should not fear death and instead embrace the assurance of heaven. We should be willing to provide mercy care, we should be willing to help others provide mercy care, and we should be willing to accept the help of others who wish to join us in providing mercy care during the difficult time nearing end-of-life. All the while, as believers, we should be looking forward to the celebration of eternal life in heaven to come.
I pray that today’s session has been helpful for you as you navigate this difficult terrain.
The decision for hospice care should not be taken lightly. It should be prayed about, well thought out, discussed with family, discussed with one’s pastor, and discussed with one’s physician.
However, we must not put unnecessary and unbiblical burdens on ourselves or others by feeling forced to go through treatments that bring pain and suffering without much benefit. We need to be willing to persevere when God is leading us to fight and willing to accept death when God is ready to take us home.
(Slide Closing 1)
This presentation has been put together to strengthen the faith of believers and to challenge the unbelief of others. I pray that you have found this presentation helpful.
Also, please note that this 10-15 minute presentation cannot exhaustively address most issues. My prayer is that it stimulates you to personally research further, and I am assured that you will find the Word of God proven time and time again.
(Slide Closing 2 with outro music)
Feel free to email any ideas you would like to see addressed by emailing me at crosspointewv@gmail.com. There are slides prepared for each of these presentations which can be accessed at our church website at crosspointefamily.church and select ATG. God bless and have a blessed week.