Some Hospice Care Providers Enforcing State-Sanctioned Euthanasia Through IL Probate Courts

RFFM.org ^ | August 13, 2010 | Anonymous

[Daniel T. Zanoza]

Letter to the Editor by "G"

EDITOR'S NOTE: In 2008, RFFM.org ran a series of columns dealing with end of life issues, including the dangers presented by living wills and information regarding how some hospice care providers are hastening deaths of the elderly. RFFM.org has received numerous firsthand accounts which confirm the information offered in the series and the following letter to RFFM.org illustrates how the state may be complicit in the euthanasia of the aged with the assistance of Illinois courts. This situation may also be occurring outside of Illinois as well. It is a must read for senior citizens, their families and loved ones. It also points out every American should be vigilant of an anti-life agenda which is being advanced, for the most part, without the public's knowledge. The letter below is not a piece of literary perfection, but it is an articulate description of what is happening, all to often, across the state of Illinois and possibly our nation.

My Dad just passed away while under hospice care. I believe they killed him. After leaving the hospital to go into a nursing home--because the hospital said he was not ready for hospice--he was very alert and had a strong drive for life. He'd whisper to me about others that were dying when, in fact, my siblings had planned an end to his life. My Dad refused physical therapy and was then put into hospice. Since I spent a lot of time with him--and not the usual 45 minutes once a week as my siblings would do--I know that if he was tired from a poor night's sleep (up to urinate a lot) then therapy and food intake would be affected, as it would be with any of us. My brother and my sister were his proxy and acting as his proxy before he was declared incapable of taking care of his own affairs. He tried to contact his lawyer to be his own proxy and in a meeting at the nursing home he said he wanted to be his own proxy, but it was too late, they already decided to end his life. Again, ignoring his wishes when, in fact, they were not legally his proxy at that time.

I was constantly threatened by my siblings as I tried to help my Dad speak for himself, i.e., be at his own meeting, to which they had another meeting immediately after the one he was at, in order to arrange his death. My Dad was an inconvenience to my siblings--their time share properties, their retirement days, etc. and the money from his will would become less for them to have if he went on living with the nursing home costs. My Dad had COPD and was on oxygen, but he was in no pain. He was in a wheelchair, but wanted to keep using his legs to maneuver himself and he wanted to go to the bathroom himself, get himself into bed, dress himself, etc. but he was told they'd bring in the police--if he kept trying to do these things for himself. He became very intimidated, having to wait 20 minutes or more to go to the bathroom and would sometimes mess his pants while waiting for an attendant and be embarrassed. He'd tell me how he had to wait to go to bed, one night from 7:50 until 9:40 to get into bed. He was nervous that, if my visits were long, they'd make him wait even longer for his needs to be met and he would draw further ire from those in the hospice care facility. My Dad was taking eight pills or more, all at once, no throat closing up (as they said it would), in order to justify the need to prescribe him morphine. One Monday, I was going to take him to his favorite place to eat and I was told I could not take him, although my siblings were not yet declared his proxy--one week later, my Dad is dead.

I consistently found his oxygen would be on 0 or not hooked up after a nebulizer treatment, and he would then be without oxygen for hours before my discovery. I found the nebulizer cartridge filled on the floor near his bed. With these constant errors, I wonder what else was done to him which hastened his death. I was not allowed to see his medication, and then they were taken away and he was sedated to sleep and morphine was administered--when, in fact, he explicitly told the staff he did not want no morphine. I wish I had pursued an autopsy to verify my Dad died from a morphine overdose, but feeling threatened just by visiting him, made me fear to pursue what was the right thing to do--when wrong had been done.

RELATED ARTICLES:

The following The following series of columns related to end of life issues were posted on RFFM.org and written by Bill Beckman, Executive Director, Illinois Right to Life Committee http://www.illinoisrighttolife.org

Stephen Bloom, a Christian Attorney at Law and an expert on living wills http://www.istherealawyerinthechurch.com/ and

Daniel Zanoza, Executive Director, RFFM.org

Part I The Myth Of Living Wills: You Are Actually Signing Your Life Away by Bill Beckman posted August 11, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/the-myth-of-living-wills.html

Part II How a Living Will can bring about your premature death by Bill Beckman posted on August 12, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/how-a-living-will-can-bring-about-your-premature-death.html

Part III Futile Care--Knowing What It Is May Save Your Life Or The Life Of A Loved One by Bill Beckman posted August 13, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/part-iii-futile-care--knowing-what-it-is-may-save-your-life-or-the-life-of-a-loved-one.html

Part IV Research on "brain dead" and "almost dead" patients declared "ethical" by Bill Beckman posted August 14, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/part-iv-research-on-brain-dead-and-almost-dead-patients-declared-ethical.html

Part V Choose Hospice Care Provider Carefully: Using Hospice Care To Hasten Death Declared "Ethical" by Bill Beckman posted August 15, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/part-v-choose-hospice-care-provider-carefully-using-hospice-care-to-hasten-death-declared-ethical.html

Part VI Some Hospice Care Providers Hasten Death Through Use Of Morphine Overdoses + Other Means? by Bill Beckman posted on August 16, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/part-vi-some-hospice-care-providers-hasten-death.html

Part VII Culture Of Death Taking Toll On Those Nearing Life's End: Overview -- by Daniel T. Zanoza posted on August 17, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/part-vii-culture-of-death-taking-toll-on-those-nearing-lifes-end.html

"Living Will" Becomes a License to Kill: The Horror Goes On In 2008 by Bill Beckman posted on August 18, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/living-will-becomes-a-license-to-kill.html

Living Wills: Signing Your Own Death Warrant? A Christian Lawyer’s Perspective by Stephen Bloom posted on August 19, 2008 at http://rffm.typepad.com/republicans_for_fair_medi/2008/08/living-wills-signing-your-own-death-warrant-a-christian-lawyers-perspective.html

[PGalt]

Thanks very much for posting.

life

[Pecos]

One basic question always applies - Who do you trust with your life?

[MEGoody]

Sadly, those who are supposed to love you will sometimes wish you dead because of greed or just because they don't want to be bothered with you.

I was caregiver to my mom for many years. I would not give up the blessing of that time with her for anything.

People don't know what they are missing by being so selfish. I guarantee, I got much more from my mom than I gave.

And no, I'm not talking about money. Some people are quite surprised to find out we took care of her for so many years, yet she didn't have a penny to her name.

What a sad world.

[yefragetuwrabrumuy]

Be advised that a lot of health care institutions are taking a “passively hostile” approach to older patients—and that it is likely to get much worse.

While the assumption is that this is “active hostility”, and there may indeed be some of that, the “passive hostility” is much greater, and even gives rise to active hostility.

To start with, geriatric care is increasingly like working in an animal shelter. The mood is that the life of all the patients is almost over, by one means or another, fast or slow, and that there is a long waiting list to take the place of them when they die.

The majority of patients are elderly women who have outlived their spouses, and are in a state of rapid physical and mental decay. To visit such a place is disturbing. Dozens of elderly women in wheelchairs, all lined up in the corridors, staring absently at the blank wall in front of them.

This is an awful psychological state to be in for health care workers, because it makes them prone to “false empathy”, in which they think that a patient is demented, but suffering and in pain, and they have been abandoned by their family. It is worst when they are bedridden and unresponsive.

So it is easy for them to think that “When this person dies, their bed will be available for someone else who is still awake, aware, and needs medical care. So if they will just die...”

Add to that the legal pressure placed on them for liability and responsibility over a contentious situation they have little control over. For example, disputes between children over the life and death of a parent, both sides using dueling lawyers who lean very hard on the health care workers.

Finally there is active hostility. This is now happening across the US, except in hospitals where it is very strongly discouraged. It can be seen in many emergency rooms when older patients are automatically put at the end of the line for treatment, and often told to wait for hours to see if their condition improves on its own.

For this reason, elderly patients sent to ERs should always be accompanied by a younger, and a little angry looking, relative. The squeaky wheel does get the grease.

And even though there is an extended wait, waiting for them during and after surgery, until they are comfortable and bedded down, as well as calling them around meal times, to ask if they have been fed and their needs attended, is essential. No longer assume that this will be done automatically.

With the huge number of baby boomers soon to enter the system, what is bad right now will likely become horrific.

[ladyjane]

Don’t trust hospice. My experience with them has been extremely negative. I realize others have had good experiences but my experience with them was a nightmare.

[chuckles]

I hate to break it to you, but when you choose Hospice care, you won't make it out alive. It is their job to kill you. I know because I have had 2 in my family recently. They are instructed to withhold care that prolongs your life.

If you are suffering from COPD, they will not give you anything that will help the COPD. If you fall and break a bone, they must treat the broken bone, but nothing else. After a period of time, they start the morphine and you will receive more and more until breathing stops.

I have found many people that don't understand the purpose of Hospice. Hospice is there to end your life peacefully. Getting better from your malady is not in the cards. This was the problem with Terri Shivao. She was in Hospice care and wouldn't die, so they had to murder her outright. They even stopped brushing her teeth to hope an infection would get her.

When you call Hospice you should be ready for a funeral because that is what they are paid to give you. I've found many people that somehow thought their loved one would be allowed to get better and come home if that's what God wanted for them. You give that up when you sign the papers. There also seems to be a time limit. If you aren't dead within a couple of weeks, they step up the morphine. Many people die from something as simple as a UTI because they won't treat it. If you say you want it treated, they withdraw Hospice. The whole purpose is for you to die, not get treatments to save you.

[Pecos]

I understand your point, but you may have missed mine. I never said that I would trust an organization or institution with my life.

[Daniel T. Zanoza]

These are some great points, but the letter to the editor from “G” probably did not address the fact some relatives—for their own financial gain—are using the courts to get power of attorney or get the probate courts to assign a guardian ad litem. Often these individuals are seeking financial gain from getting an elderly individual deemed incompetent and the courts themselves assume power of attorney which trumps not only the wishes of the families, but the patients themselves who may not have a disease which would likely result in their death. These guardians ad litem and other officials of the court have one job...and that’s to serve their own best interest.

For example, recently a 94 year young woman—who was bright and alert—was declared incompetent by a relative who went to court in Illinois. This individual embezzled hundreds of thousands of dollars from this lady who was looking forward to her 100th birthday. The court and a physician ruled in his favor, stating the woman had Alzheimer’s—which was NOT the case. She did have some short term memory loss, like many in that age bracket and younger. The woman was put in hospice care and, ultimately, died from the administration of pain-killing drugs, including morphine and phentanol.

I have never heard of a case where Alzheimer’s is painful and the diagnosis required powerful drugs like morphine. This woman was NOT in pain. All of the other family members did NOT want her in hospice care, but the one individual who embezzled money from this lady got his way and the courts were complicit in this lady’s death.

Hospice care can be a compassionate alternative to a painful, lingering death, but it should not be used to hasten death or implemented to bring on death in patients who are not terminal.

There is a Patient Self-Protection Document that everyone should fill out in place of living wills. One of the many related articles in the RFFM.org end of life series discusses this document. The document can be downloaded from the Illinois Right to Life Committee’s web site at this link: http://www.illinoisrighttolife.org/pspdoc.htm

As correctly stated in one of the above comments baby boomers will make what’s happening today look like a walk in the park for senior citizens.

Seniors should always be accompanied to an Emergency Room by someone who truly cares and the hospital staff should realize this fact from the get go. Yes, as yefragetuwrabrumuy wrote, the squeaky wheel does get the grease and I made sure I was the squeakiest wheel in the entire hospital whenever I accompanied an elderly person.

Again, some great points, but we should NEVER get to the stage where the “Final Solution” is applied in the treatment of the elderly. If light is not shined on this issue quickly, we will make the numbers of those who died in Hitler’s Germany and his death camps look miniscule by comparison.

Once more, I suggest downloading the Patient Self-Protection Document from the Illinois Right to Life Committee’s web site http://www.illinoisrighttolife.org/pspdoc.htm. I have to get on this myself and quit talking or writing about it and do it.

Dan Zanoza

[Paleo Conservative]

I hate to break it to you, but when you choose Hospice care, you won't make it out alive.

In my father's case there really was no hope of his recovery due to a brain hemorrhage that could not be controlled. We transferred him to hospice care after consulting with neurosurgeons who said that due to the massive damage to the left hemisphere of his brain, there was no way he could recover even if they were to perform surgery. His brain functions were so damaged that he couldn't even cough up the phlegm that was accumulating in his lungs. There was no use in continuing medical treatment for his various ailments, and the continuation of hydration and nutrition would only result in his making even more phlegm which would create an ideal medium for growing bacteria which could lead to pneumonia. His breathing the day before he died was really hard to watch. He died within 16 hours of removing hydration and nutrition.

[Lil Flower]

Wow! If this is the treatment you have seen then you should report them to the state. Hospice is the exact opposite of what you have stated. When you have a patient that is on hospice for COPD, then you HAVE to treat the symptoms associated with COPD with O2, nebulized meds, and any complications related to COPD such as URI with antibiotics. However, if they get a UTI while under services for COPD, the nurse still informs the Dr and gets antibiotics to treat the UTI, but hospice doesn’t cover that antibiotic. And yes Hospice services are withdrawn if the patient gets better, as it should be. However, they are usually transfered to home health for a time to make sure they are still getting better. I’ve worked in hospice for 3 years and have never seen anything like what you have seen. It should be reported.

[BykrBayb]

So if you have a patient with terminal cancer, and you discover she’s getting chemo, you wouldn’t deny her services? Be honest.

[Lil Flower]

Yes because medicare guidelines state that if a patient is seeking treatment (chemo) they don't qualify for hospice. And if you keep that patient on hospice, medicare will make you pay that money back plus a hefty fine. However, that same patient would qualify for home health. Now, you CAN have a pt on hospice if they are receiving chemo for palliative/comfort such as, if the pt has a throat cancer and radiation and or chemo would shrink that tumor to allow the pt to swallow. But a pt should not be referred to hospice until there is no hope/treatment left that will cure and or the pt does not want any further curative treatment. A company that admits a pt who is not terminal is committing fraud.

[ladyjane]

My response was a general one, not intended for you personally. I got your point!

[BykrBayb]

That’s what I thought. Thanks.

[momto6]

While I don’t think that these stories are lies, I find them so so difficult to believe. I work in a hospital that has 99% end of life care and occasionally hospice. There are people who have had strokes and been there for 10-12 years not able to speak or sit up by themselves. There are also the grandmothers and grandfathers that simply can not live at home because they forget to take their medication. Every one of these people are treated to the absolute best of our ability. I personally treat each and every one of them as though they were my grandparent.

My understanding of hospice (and I could be wrong) is that conditions will not improve at all and there is NO hope of any cure. Their job is to help the family through the natural end of life period.

Again I am just appalled at these stories, I love each and every one of my patients. I try to make each one of their days a better day, and I see them trying to do the same for me. I grieve when they die (and they do) the average age for our place is in the mid 90s. I have sat with many patients after my shift just because they were lonely and their family is not there.

I have to believe that there are a lot more places like ours out there than there are the horror hospitals that make the news. The good places just don’t have stories that sell papers. Call me Pollyanna but I don’t care.

[BykrBayb]

I think it’s disgusting that patients who are almost certainly going to die very soon cannot receive comfort care if they even attempt to live.

[FourPeas]

As I understand it, hospice care is for people whose prognosis is that they have 4 months or less to live. So, yes, it is expected that when someone goes to hospice, they will die there. All the agreements I’ve seen spell it out pretty clearly that the hospice organization is the one that determines what sort of care the person receives. Entering a relative in hospice generally signs away all rights to determine medical decisions.

THAT SAID, a family member of mine DID leave a hospice and live another 15 high quality years. The doctor didn’t bother to do the actual test to determine their condition; he just guessed. After 4 months, she was transferred to another hospice and eventually another doctor took a look at her records. One relatively simple surgery and she went home a few days later to fully recover.

[Lil Flower]

There seems to be a lack of knowledge about what hospice actually does and what it is for with the general public,and Dr's. And unfortunately some companies will play fast and loose with the rules to get that medicare money by admitting patients that are not appropriate, you know they have early stage COPD and only need O2 occasionally and still go to the casinos 3 days a week. Hospice can really be a blessing to families and patients,if the nurses are compassionate and follow the law. Hastening someones death is illegal, immoral, unethical, etc.

[BykrBayb]

Not everyone who disagrees with some of hospice’s rules and methods are just plain ignorant. Sometimes we disagree because we do know. All too well.

[Lil Flower]

If companies, nurses, etc are doing that to patients then you are right, it is disgusting. I’ve never seen that in my practice. The patients comfort is the absolute top priority!

[BykrBayb]

Unless they attempt to cheat death. Then they’re booted out the door.

[1951Boomer]

“Some people are quite surprised to find out we took care of her for so many years, yet she didn’t have a penny to her name.”

You are my hero. God bless you for your sacrificial love. He took note of every single act you did for your mom.

[Lil Flower]

I must respectfully disagree with your post but only because working in hospice I know that the individual patient never gives up their right to determine there healthcare/treatment.In fact, many patients on hospice do not sign a DNR waiver and are a full code nor do they have to sign one.I’ve. Admitted patients to hospice and then 3 days later they decide they do want to try chemo, etc. and they have every right to do so. I would never be involved with forcing a patient to do anything they didn’t want to do.

[FourPeas]

The agreements I’m familiar with from Michigan do just that. I had quite an in-depth discussion with a hospice nurse when discussing my dad entering hospice. My mother chose not to go with hospice for this very reason.

[BykrBayb]

NJ has the same rule. When you sign up for hospice care, you agree not to seek treatment from anyone other than hospice, and you agree to receive only comfort care from hospice. A prognosis of death within six months is a requirement, along with your agreement not to try to improve your odds.

[Lil Flower]

Hospice is “end of life” care. That's all it is. If you are not at the end of life, then you should not be on hospice services. Saying that they are booted off is disingenuous. They are not denied medical care, only hospice services. They can still have home health, go to their Dr. Etc. Having them on services when they are not dying is fraud. Its no different than an individual lying about their income status to get food stamps. That is fraud. For a hospice company to have a patient who is not terminal ( reasonably 6 months or less) is committing fraud and can be fined and put out business. Nurses involved in that fraud can lose their license.

[BykrBayb]

Your analogy is all wrong. It’s not the same as having an income while receiving food stamps. It’s the same as applying for a job while on food stamps. Do you think people should be kicked off the food stamp program for applying for a job? If not, then why should terminally ill people be kicked out of hospice for grasping at the remote hope of recovery?

[BykrBayb]

For a hospice company to have a patient who is not terminal ( reasonably 6 months or less) is committing fraud and can be fined and put out business.

No one is saying otherwise. The problem is that patients are not permitted to seek treatment for the terminal condition. They are required to agree, in writing, to give up any hope of recovery. They're denied comfort care unless they give up the fight. That is wrong. That is so wrong.

[Lil Flower]

I practiced in Mississippi so I can’t really speak for Michigan. It is also possible the nurse wasn’t sure what she was talking about. I certainly hope Michigan is not like that. Someone mentioned earlier in the thread that Terri Shiavo was on hospice. Actually from what I read about her condition, she shouldn’t have been because she was not dying. But it is also why removing her feeding tube and starving her to death was murder in my opinion.

[Lil Flower]

You’re right about the fact that they have a choice to sign up for hospice or not. They are not forced to do so nor are they forced to stay on hospice. They are not denied comfort care if they choose to seek treatment for their illness. They can and do still receive comfort meds, etc through their physician. They just can’t be on hospice. I’m sorry I must not be doing a very good job explaining this.

[BykrBayb]

Is hospice for patients who are terminal, or patients who agree to die? There is a difference. If a terminal patient signs papers agreeing to follow a course of treatment aimed at guaranteeing their death within six months, then they qualify for hospice. If the same patient, with the same terminal condition attempts to live, they don’t qualify for hospice. They will almost certainly die within six months despite their desperate attempt at benefiting from treatment, but they will die without hospice care because they refused to give up.

[BykrBayb]

How about if instead of making them sign an agreement to cooperate with death, you let them stay in hospice as long as they’re terminal, and only boot them out of hospice when and if they are no longer terminal? Is that too much to ask?

[Lil Flower]

My goodness! If you think that hospice is signing up to agree to die or to follow a treament that results in your death,then you must have had a horrific experience with hospice and I am so sorry. Hospice is nothing like you have described. Again, I am sorry you feel this way about hospice care. I can tell you that as a conservative christian I would never be involved with.anything you have described.

[BykrBayb]

Does that mean that a terminal patient is allowed to get treatment for their terminal condition while receiving hospice care? Make up your mind. In some posts you claim they are, and in other posts you claim they aren’t. Either they are, or they aren’t. You can’t have it both ways.

[Lil Flower]

I have really tried my best to explain this to you. You have you’re mind about hospice and obviously no one is going to change. I said that the symptoms are treated, maybe you could go back and read my posts again because I don’t wish to repeat myself. Hospice is palliative care, not curative. If you want curative, don’t get on hospice. If you want palliative, then you go with hospice. I’m sorry I can’t explain it any better than that. Although I do think you are unwilling to accept/believe anything I’m saying.

[BykrBayb]

Hospice provides types of care that are simply not available to most people anywhere else. The myth is that its availability is based on the patient being terminal. Then why isn’t it available to terminally ill patients who are still getting treatment for their terminal disease? Why must the patient agree to give up trying to live?

[BykrBayb]

Maybe I’m the one that’s not being clear. I don’t mean to suggest that hospice should provide chemo or other curative treatments. I just don’t think they should deny services to people who seek curative treatment while they’re dying. Knowing that you’re dying doesn’t necessarily mean that you want to die. I don’t think we should be denying comfort care to people who are dying, on the basis of whether or not they’re cooperating in their own demise. I think we should be allowed to fight against death without risking the comfort care we need. Hospice care should be provided to people who are dying, even if they don’t want to be dying. Even if they actively seek alternatives to dying. If they succeed in cheating death, then take them off hospice, because then they don’t need it. But if they fight against death, and they’re losing the battle, but still refuse to stop fighting, don’t deny them the care they need. I understand hospice is supposed to be palliative care for dying people, and they don’t provide curative treatments. That is not the issue.

[MEGoody]

Awww, thanks.

Whenever mom acted embarrassed because of the things I had to do for her, I always reminded her she was doing me a favor by allowing me to earn jewels for my heavenly crown. That always made her smile.