Suffering, meaning, and the goals of hospice care

Abstract

In the mid-70s, a handful of naive hospice pioneers imagined that our movement would dissolve at the turn of the century.We hoped that what hospice stood for, by then, would be folded into the practice of medicine; our hyperbole about attentive accompaniment of In the mid-70s, a handful of naive hospice pioneers imagined that our movement would dissolve at the turn of the century.persons through life's final adventure would have become standard discourse. Medicine would have learned, to summarize Eric Cassell's preface to The Nature of Suffering and the Goals ofMedicine, that bodies do not die, people do.Grounding the dream required that we first establish what we were not. We were careful to present ourselves as more than refugees from the anti-institutional 60s. We did not allow ourselves to be identified on the mushy side of emerging facile distinctions in the health care industry, between art and science, soft touch and high tech. We were uncomfortable with these continuums and at havingbeen consigned, by the purveyors of real medicine, to the Marcus Welby end of them. Therefore, we were careful not to be codified as simple dispensers of niceness to patients and their families with a quality assurance program that consisted of passing around and filing sweet letters about us to the editor. Furthermore, we convinced the Doubting Thomas side of ourselves that we were doing more than playing a Cartesian game of creating new, and balancing existing, categories of treatment in order to carry a better and bigger stick of services for the dying. Sadly, such phallic posturing is what health care agencies and hospice programs often seem to be doing as they flirt with each other about possible collaborations. Health care agencies need hospice's We were building a systematic and disciplined approach for understanding the phenomena of We's end in, under, around, through, and beyond the medical, psychologica4 social, and religious classifications assigned to terminal illness by the healing system.white hat and prospective billing system. Hospice needs reimbursement mechanisms for service to prehospice patients as well as larger economies of scale. That we were right in our conviction to be something other than the new kid on the same block in the helping business Bill Wallace is a priest

Untaming Grief ? For Palliative Care Physicians

“…Wallace posited that “the single most important factor in being a hospice-healer is the ability to remain present in the midst of profound powerlessness.” 36 Being present in the face of unyielding loss and reactive grief accentuates the depth of human frailty as well as the “promise of death.” 37 Grief is a permeating human theme that resists postponement and demands attention. But grief can only be palliated as medicine is ultimately impotent over death.…”