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Comment by hammock | Hacker News Reader

Is hospice just slow euthanasia? My experience is they give you successively higher doses of morphine until your body fails, over like 2-6 weeks

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Hospice is any care for the terminally ill where the quality of life is prioritized of quantity/length of life.

Hospice care can last months or years, and takes many different forms. Some people want to die without drugs and that is an option. Hospice care frequently involves spiritual, and mental care as well.

In short, no it isn't euthanasia. Hospice care does not involve actively shortening your life, rather it is just transitioning away from treatments that lengthen your life.

The act of entering hospice for someone who is terminally ill is electing to die rather than doing all that is medically possible to survive. Typically that isn't much at that point. Given that you are entering "comfort care", and likely stopping all treatment, you are effectively shortening your life.

My heart breaks for anyone that has to watch their loved one wither away. Even more so for those without loved ones to care for them til the end.

Someone who is terminally ill doesn’t get to elect to die. The disease has already done that for them. Timing is the only thing they get any say in.

There is a big difference between not taking treatment to extend your life, and seeking treatment to actively end your life. That’s the difference between most hospice care and assisted-suicide/euthanasia.

Hospice doesn’t even necessarily mean ending all life extending treatment. It’s a realignment in process where the quality of the patient's existence is the top priority. Patients can elect to continue some or all of their treatments.

People in hospice are not choosing to end care that could save/extend their life. In the majority of. Often they continue treatment while in hospice, but the terminal diagnosis means hospice is a better choice for their quality of living than staying in the hospital or at home.

Hospice is basically when the purpose of medical care goes from preserving life to maximizing comfort. It can be months of fairly normal life or a quick descent.

Often, but not always, patients are able to converse with loved ones, etc. While the ever increasing amounts of morphine are common, part of the reason is that actual tolerance for morphine with the pain of some end of life situations is much higher than you would suspect. Given that there is no risk of addiction (like there would be after a broken bone heals), the amounts are much higher than in other cases. However, to address your concern, the patient isn't normally high 24/7 waiting to die. They are not in pain and living out their last time on earth.

Nobody goes into hospice with a meaningful chance of survival. Your body is already failing. Hospice eases the often incredible pain of your body failing in terribly undignifying ways. Certainly the morphine doesn't do anything to increase your longevity, but it's not doing much to hasten your already-imminent demise.

It's palliative care for people at end of life. Morphine in this context is no more euthanasia than allowing the ill and infirm to make peace with their loved ones and emotionally accept their fate.

Life is slow euthanasia.

Morphine doesn't really cause "body failure", particularly if there's extended tolerance being developed and maintained. Methinks there's a seperate etiology in play for the scenario you describe

My sister is a (non-profit) hospice nurse, and according to her the record at her employer for how long someone remained on hospice without dying was 15 years.

I guess ex-Presidents get an extension:

https://www.latimes.com/world-nation/story/2023-05-23/jimmy-...

It really just depends on the illness and how it progresses, which is hard to predict. Both my grandparents died of cancer; my grandmother spent close to a year in a hospice, using quite a lot of morphine, slowly fading away, while my (otherwise fit and active) grandfather went from "I've got a stomach ache, better see a doctor" to "dead" in about two weeks.

No, my wife has had patients that have been on hospice for over a year. In order to get benefits they have to be demonstrably in decline.

Yea that’s not true. You should take hospice for you and your family rather than spend your last days in the ICU clinging to life.

If you stay full code when you do go you’ve been intubated so long they put in a tracheostomy; you’ve been unable to feed yourself so they put a gastrostomy tube in; you can’t filter your own waste and also can’t maintain blood pressure for normal dialysis so you’re on continuous renal replacement therapy; and because you can’t maintain blood pressure you are on increasingly large vasopressors which cause progressive ischemia of your limbs, bowel, and what’s left of your kidneys.

After all this your heart goes into various tachyarrhythmias requiring multiple episodes of CPR during which your sternum is fractured and multiple bilateral ribs are fractured. You suffer from esophageal rupture and bilateral pneumothoraces requiring bilateral chest tubes. Air constantly leaks into your soft tissues and you literally crackle like wet rice krispy cereal when you are touched.

That’s OK though you’re still not dead. You have time to develop multiple areas of skin ulcerations in your dependent/weight bearing areas even though you’re repositioned constantly by your nursing staff. These wounds progress and quickly extend through your atrophied gluteal and paraspinal musculature and reach your pelvic bones. You become infected by MRSA and have osteomyelitis and sepsis. Your blood pressure is still difficult to maintain and you require constant maintenance fluid and fluid boluses. Your nutrition is poor and albumin very low despite supplementation and trickle feeds so you develop anasarca, pleural effusions, and ascites. So now you appear grotesque - puffy from edema, skin crackling from subcutaneous emphysema, purple and contused from CPR, fingers and toes black and curled from pressor induced ischemia. There are tubes everywhere coming out and going into you. They’re in your throat, belly, and chest walls, central lines are in your neck for pressors and CRRT. Various machines surround you with alerts sounding almost constantly.

After all this your stress dose steroids have suppressed your immune system and you experience a reactivation of varicella and get Herpes Zoster across multiple dermatomes. Your skin is blistered and red in multiple areas and you are put in isolation to prevent spread of varicella pneumonia.

Finally after many weeks of decline and isolation your pupils are non-reactive and you lose brainstem reflexes. A CT shows diffuse hypoxic encephalopathy with herniation and brain stem compression. Because you’re full code and your “loving” family won’t accept death (over the phone now, it’s been a long time and you’re non- responsive and in isolation anyhow) a nuclear medicine cerebral perfusion study is done and it shows no blood flow to the brain. Now you can finally be declared dead.

Your family has already mourned your passing and had been going through the motions. You’ve been sedated and in isolation for weeks now and never got to say goodbye.

Your spouse is left with an enormous medical bill but there’s no money anyways so it goes unpaid.

The end.

A dead patient is probably not as profitable as a continously dying one. These vultures will probably try to keep these poor people alive as long as they have money to spend and then kill them off when there is nothing left to collect.

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