Hospice care has seen a resurgence recently. With health-care costs increasing steadily, people's desire to die with dignity, and a federally mandated requirement to discuss "living wills" during every hospital admission, more and more people are considering hospice care at the appropriate time.

Rather than being a morbid field of medicine, hospice care celebrates life. Patients and family are relieved of the burden of denial (and huge medical bills) and can explore the last days together in a more open and loving fashion. Death is a part of life that is ignored by most people, including practitioners of the medical arts. Therefore, there is a huge need for physicians and associated health care team members who are trained in the art of terminal care.

Often, health care workers are unwilling to prescribe adequate amounts of pain medication for their terminal patients. This is the result of ignorance (of the massive doses sometimes required) and lack of common sense ("I don't want to get them addicted to this stuff.") which is understandable, in that most of health care training is in the healing arts; death is usually considered to be failure.

However, when death is inevitable, it cannot be seen as a failure, but merely as an end to life. The fact that so many practitioners find this concept so difficult to incorporate into their world view speaks to the overwhelming strength of the "healing art" paradigm. Again, this demonstrates the need for physicians and other health care workers who are interested, and specialize in, terminal care. We cannot ignore terminally ill patients, and in fact, are ethically required to make their death as comfortable as possible.

Families who understand the hospice model are generally amazed at the outcome of hospice intervention. Instead of being herded into crowded ICU waiting rooms, they are able to stay with their loved one, and help them cross over. Families who witness this process find that there is less of a "hole" remaining in their lives afterward. This contrasts with the experience of those who are called into the intensive care unit after a lengthy critical care process, only to view the body of their departed family member. Hospice care removes part of the mystery of the process of death, and is a growing experience for all who are involved--patient, family, and health care workers.

If you have questions or comments about hospice care, feel free to write. There are no "stupid questions", so feel free to ask anything you like.

Steven Baumrucker, MD
Medical Director, Adventa Hospice
Medical Director, Palliative Care Service, Wellmont Health System
Assistant Clinical Professor, ETSU College of Medicine
Associate Editor-in-Chief, The American Journal of Hospice and Palliative Care