Hospice care is one of the fastest-growing segments of the U. S. healthcare system, a trend that is expected to accelerate as the median age of the population continues to rise over the next three decades. Despite over forty percent of the population now dying while on hospice care, very little has been published on the ethical opportunities and challenges experienced in the everyday lives of those giving and receiving hospice care. This book is the first comprehensive collection devoted to analyzing distinctive ethical issues arising in the delivery of hospice care and designed to promote best ethical practices for hospice care professionals and organizations. Thirteen newly commissioned chapters by seventeen hospice experts populate three thematic sections of the book, each devoted to an aspect of the intersection between ethics and hospice care. Contributors have unique qualifications and abilities to articulate and respond to ethically significant phenomena that - while not always unique to hospice care - arise in especially poignant and complex ways when caring for patients enrolled in hospice.
As the shift or return to home-based care at the end of life continues, hospice professionals and programs will be faced with a broader array of terminal illnesses, cultural beliefs and traditions, and patient and family values than ever before. Hospice will no longer be tailored solely to the final stage of cancer, but will need to accommodate patients whose illnesses are variable in their progression and whose treatment plans include many medical options. The ethical orientations and frameworks that have served hospice for the past 50 years will need to be supplemented and refined if hospice is to fulfill this changing social mission. Hospice Ethics explores a new paradigm for hospice ethics from a multi-disciplinary and provides an important educational resource for professional training in end of life care.
Timothy W. Kirk, PhD is currently assistant professor of philosophy at the City University of New York-York College where he specializes in philosophy of nursing and healthcare ethics with an emphasis on hospice and palliative care. In addition to his appointment at CUNY, he serves as ethics consultant to VNSNY Hospice and Palliative Care and Adjunct Assistant Professor in the New York University Department of Population Health's Division of Medical Ethics at NYU Langone Medical Center and in the NYU College of Nursing. Bruce Jennings is Director of Bioethics at the Center for Humans and Nature and teaches ethics at the Yale School of Medicine. He has published widely on ethical issues in end-of-life treatment decision making and palliative care. He has served on the Board of Directors of the National Hospice and Palliative Care Organization and on numerous hospital ethics committees in the New York metropolitan area.
Contributors ; Introduction ; Bruce Jennings and Timothy W. Kirk ; Section I: Hospice: The Emergence of a Philosophy of Care ; 1. "From Rites to Rights of Passage": Ideals, Politics, and the Evolution of the American Hospice Movement ; Joy Buck ; 2. Hospice Care as a Moral Practice: Exploring the Philosophy and Ethics of Hospice Care ; Timothy W. Kirk ; Section II: The Interdisciplinary Team: Ethical Opportunities and Challenges ; 3. The Pharmacist as an Integral Member of the Hospice Interdisciplinary Team ; R. Timothy Tobin ; 4. The Continuingly Evolving Role of the Hospice Medical Director ; Joan Harrold ; 5. The Interdisciplinary Team - Integrating Moral Reflection and Deliberation ; Terry Altilio and Nessa Coyle ; Section III: Organizational and Policy Ethics in Hospice ; 6. Ethical Issues in the Care of Infants, Children and Adolescents ; Marcia Levetown and Stacy Orloff ; 7. The 'Patient-Family Dyad' as Interdependent Unit of Hospice Care: Toward an Ethical Justification ; Patrick T. Smith ; 8. Inpatient Hospice Care: Organizational and Ethical Considerations ; Tara Friedman ; 9. Ethical Issues Associated with Hospice in Nursing Homes and Assisted Living Communities ; Jean C. Munn and Sheryl Zimmerman ; 10. Cardiopulmonary Resuscitation in Hospice: Ethically Justified or an Oxymoron? ; Muriel R. Gillick ; 11. Moral Meanings of Physician-Assisted Death for Hospice Ethics ; Courtney S. Campbell ; 12. Ethics Committees for Hospice: Moving Beyond the Acute Care Model ; Jennifer Ballentine and Pamela Dalinis ; Section IV: Ethics and the Future of Hospice ; 13. Design for Dying: New Directions for Hospice and End-of-life Care ; Bruce Jennings