Living life fully to the last breath: The goal of hospice care

What is the role of medicine? Throughout its history, that question was answered this way: 1) to cure sometimes, 2) to relieve often, 3) to comfort always. 

With the discovery of penicillin and its effective utilization (beginning in the 1940s) to overcome life-threatening infections, the process began of reversing the “comfort always” to “cure always.” 

The endless array of medical interventions available today has improved the well-being of countless people in significant ways, including large increases in the average lifespan. In the early 1900s, the average lifespan was 48. That has dramatically increased in modern times. 

The challenge for us today is to realize when enough is enough. In other words, we do not know when to quit when it comes to curative medical interventions and when to move patients to those medical treatments focusing on comfort care. 

President Jimmy Carter offers a prime example of the challenge involved in making the movement from curative to palliative (comfort) care in a hospice program. After dealing for several years with melanoma and metastasis to the brain, Jimmy Carter decided on Feb. 18, 2023, to utilize the services of a hospice program for the last part of his life journey. 

When this was announced, the various news media were ready to publish his obituary in short order. But what is especially disturbing was the accompanying comment in the news stories that “…[H]e was staying at home to secure hospice care instead of additional medical intervention.” 

That is false. Hospice patients do not give up medical care. That is a myth constantly floating around about hospice care. Rather, terminally ill patients choose to pursue aggressive medical care that will keep them comfortable to enable them to live as fully as possible the last part of their life journey, what I refer to as the “dying role,” during which they have much living to engage in and important duties to carry out. 

In my episode of the podcast “Restoring Hope,” I give examples of patients who were able to die peacefully because they were given the necessary support by the hospice team to take care of unfinished business prior to their death. 

Did Jimmy Carter die a week after he chose the care of hospice? His death occurred Dec. 29, 2024, almost two years later. 

Unfortunately, too many patients and their loved ones choose hospice far too late. In our program (Harry Hynes Memorial Hospice), the highest number of patients under care are only with us for two days.  

That makes it impossible to give them any care beyond managing their physical comfort while they are imminently dying. Obviously, this is important. No one should die in uncontrolled pain or with unmanaged troublesome symptoms. With the many opportunities that modern medicine offers for doing so, this can realistically be achieved. 

But this limited time available does not allow us to address issues that can cause even greater suffering than what ails us in the physical dimension of our lives. Those greater challenges relate to the psychosocial/spiritual aspects of living. The interdisciplinary hospice team often needs to have time and opportunity to be more heavily involved in supporting the patient and family in these dimensions. 

Patients especially want these issues addressed prior to dying. This is what allows them to have a peaceful death. 

Another disturbing myth I hear frequently is, “Choosing hospice is a death sentence.” Even more disturbing is the myth that hospice kills people. 

Both are categorically false. 

Our philosophy at HHMH is clear: we neither prolong the dying process (which curative medical interventions can easily do) nor do we hasten death. We allow death to occur; we do not cause death. 

Hospice care does not limit the amount of time of life for patients; it does just the opposite. Patients who choose to forgo aggressive curative interventions and elect aggressive comfort care often end up not just having a higher quality of life, but they live longer. In other words, both quality and quantity. 

I saw this early on in my hospice work. Now there is ample research that bears out my observations.  

Curative medical care has a positive role in our physical well-being. That goes without question. What is also obvious is that eventually our bodies will wear out and no longer benefit from even the most aggressive curative treatments. Eventually we will all become “incurable.” After all, the mortality rate has always been the same: 100%. 

What will always be beneficial is the comfort care that modern medicine is also able to provide. We will never exhaust the possibility of benefiting from this type of medical care. 

When it comes to medical care across the ages: Cure? Yes. Relief often? Yes. Comfort always? Most definitely yes. 

Fr. Tom Welk, C.PP.S.