A recent report in the San Jose Mercury News details a lawsuit filed in Alameda County, CA, against the Miami-based VITAS Healthcare Corporation national hospice chain by family members of a hospice patient served by VITAS. They allege that she endured a painful death because the hospice failed to inform her that she could receive "palliative sedation."
I have not spoken about this case with the company or with the family of Michelle Hargett Beebee, mother of three in Los Gatos, CA, who was 43 when she died of pancreatic cancer last December. The website of Compassion & Choices, whose director of legal affairs, Kathryn Tucker, filed the suit on the family's behalf, has more details. VITAS, based in Miami, FL, is the largest or one of the largest providers of hospice care in the United States.
I know that VITAS is a for-profit enterprise, part of the same company, Chemed, that owns Roto-Rooter, but also that the company has developed innovative services aimed at improving quality of care in such areas as ethics, chaplain training and physician education. I have done work for VITAS as a contract writer, but not in the past year.
There are several factors that make this case important to end-of-life care providers. First of all, the allegations involve the clinical care provided by the hospice and whether it was able to deliver a comfortable, pain-free dying experience for its enrolled patient. In a country where "death panels" are a more typical illustration of the caliber of public discourse around care at the end of life, to actually engage with issues related to the clinical quality of death provided by the hospice surely represents some kind of milestone. Hospice's whole reason for being is to relieve dying patients' pain and suffering and provide them with an opportunty to achieve some degree of comfort and peace at the end of their lives. Countless studies have documented the larger system's failure to relieve pain and suffering at the end of life, and hospice is proposed as the remedy.
But the allegation in the California lawsuit, that the hospice failed to inform the patient that she could receive palliative sedation, touches on a complex, not-well-understood and ethically fraught treatment that is still subject to debate among medical ethicists. Palliative sedation is the use of sedative medications to relieve extreme suffering by making the patient unconscious while the disease continues its relentless march toward death. In other words, in rare cases where the patient's pain is absolutely intractable and unbearable, the palliative sedation option involves knocking the patient out, often until death, ending the experience of suffering in this way. Given the ongoing ethical debate over palliative sedation, is it reasonable to expect this procedure to be standard practice in hospice care?
Compassion and Choices grew out of the Hemlock Society, a euthanasia advocacy organization founded in 1980. It has been a major advocate for physician-assisted suicide initiatives such as those enacted in Oregon and Washington state. Hospice leaders, by and large, have historically opposed legalization of euthanasia or PAS. In Oregon, the first state to implement PAS, hospices have learned to co-exist with it, although they don't participate in administering lethal medications to end their patients' lives. Despite the controversy leading up to its implementation, it has been rarely utilized by patients, only dozens per year in Oregon, although a significant proportion of those few were receiving the care of hospice.
If lawsuits are war by other means, the case from California may signal a new front in the euthanasia/PAS debate at a time when the Scottish Parliament has just overwhelmingly rejected a bill proposing to allow terminally ill patients to "legally access assistance" to end their lives. But once again, hospice, which is dedicated to the thankless work of bringing comfort to patients at the most difficult time of their lives, may be caught in the middle.